Provider Demographics
NPI:1093941239
Name:SISTERS OF THE GOOD SHEPHERD
Entity Type:Organization
Organization Name:SISTERS OF THE GOOD SHEPHERD
Other - Org Name:GOOD SHEPHERD CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PROVINCIAL
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-278-1155
Mailing Address - Street 1:406 HEMENWAY ST
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-6751
Mailing Address - Country:US
Mailing Address - Phone:508-485-8610
Mailing Address - Fax:508-460-6372
Practice Address - Street 1:406 HEMENWAY ST
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752-6751
Practice Address - Country:US
Practice Address - Phone:508-485-8610
Practice Address - Fax:508-460-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1GK3311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110032693BMedicaid