Provider Demographics
NPI:1164702668
Name:SHEPHERD'S GATE HOME HEALTH LLC
Entity Type:Organization
Organization Name:SHEPHERD'S GATE HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:O
Authorized Official - Last Name:BANKOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-767-3836
Mailing Address - Street 1:501 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9223
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9223
Practice Address - Country:US
Practice Address - Phone:267-767-3836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-28
Last Update Date:2014-05-09
Deactivation Date:2013-10-24
Deactivation Code:
Reactivation Date:2014-05-09
Provider Licenses
StateLicense IDTaxonomies
PARN561615251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health