MEDICARE: GOOD SHEPHERD HEALTHCARE II LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	1041C0700X	Clinical Social Worker	NV
2	133NN1002X	Nutrition Education Nutritionist	NV
3	163WC3500X	Cardiac Rehabilitation Registered Nurse	NV
4	224Z00000X	Occupational Therapy Assistant	NV
5	225100000X	Physical Therapist	NV
6	2251C2600X	Cardiopulmonary Physical Therapist	NV
7	2251G0304X	Geriatric Physical Therapist	NV
8	2251N0400X	Neurology Physical Therapist	NV
9	2251X0800X	Orthopedic Physical Therapist	NV
10	225200000X	Physical Therapy Assistant	NV
11	225B00000X	Pulmonary Function Technologist	NV
12	225X00000X	Occupational Therapist	NV
13	2279P1005X	Pulmonary Rehabilitation Registered Respiratory Therapist	NV
14	235Z00000X	Speech-Language Pathologist	NV

General Provider Information

NPI Number	:	1760558696
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SHEPHERD HEALTHCARE II LLC

Provider Business Mailing Address
First Line	:	4275 BURNHAM AVENUE SUITE 255
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8204
Country	:	US
Telephone Number	:	702-893-3333
Fax Number	:	702-893-0960

Provider Business Practice Location Address
First Line	:	4275 BURNHAM AVENUE SUITE 255
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-8204
Country	:	US
Telephone Number	:	702-893-3333
Fax Number	:	702-893-0960

Authorized Official
Title or Position	:	CEO
Name	:	BENIGNO MANAHAN TUAZON
Credential	:
Telephone Number	:	702-893-3333

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	09/11/2025

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