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NPI Code Detail

MEDICARE: GOOD SHEPHERD PCA SERVICES

MEDICARE: GOOD SHEPHERD PCA SERVICES
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
13747P1801XPersonal Care Attendant
2253Z00000XIn Home Supportive Care Agency

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
29722-PCA-0OTHERNVPERSONAL CARE AGENCY

General Provider Information

NPI Number : 1770117616
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOOD SHEPHERD PCA SERVICES
Provider Business Mailing Address
First Line : 2235 E FLAMINGO RD.
Second Line : SUITE #170
City : LAS VEGAS
State : NV
Zip : 89119-5186
Country : US
Telephone Number : 702-966-7118
Fax Number : 702-839-0095
Provider Business Practice Location Address
First Line : 2235 E FLAMINGO RD.
Second Line : SUITE #170
City : LAS VEGAS
State : NV
Zip : 89119-5186
Country : US
Telephone Number : 702-966-7118
Fax Number : 702-839-0095
Authorized Official
Title or Position : PCA MANAGER
Name : MR. BENJAMIN ARCEO GALLEGOS JR.
Credential :
Telephone Number : 702-966-7118
Provider Enumeration Date : 03/01/2020
Last Update Date : 09/17/2025

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Directions to “GOOD SHEPHERD PCA SERVICES ” Practice Location

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