Provider Demographics
NPI:1235750514
Name:SOCIETY OF GOOD SHEPHERD
Entity Type:Organization
Organization Name:SOCIETY OF GOOD SHEPHERD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-403-4368
Mailing Address - Street 1:3149 MERAMEC ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4338
Mailing Address - Country:US
Mailing Address - Phone:314-403-4368
Mailing Address - Fax:
Practice Address - Street 1:3149 MERAMEC ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4338
Practice Address - Country:US
Practice Address - Phone:314-403-4368
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty