Provider Demographics
NPI:1316399017
Name:THE GOODSHEPHERD INC
Entity Type:Organization
Organization Name:THE GOODSHEPHERD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IBILOLA
Authorized Official - Middle Name:F
Authorized Official - Last Name:BISIRIYU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-220-8384
Mailing Address - Street 1:2133 W MORSE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4914
Mailing Address - Country:US
Mailing Address - Phone:773-220-8384
Mailing Address - Fax:
Practice Address - Street 1:2133 W MORSE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4914
Practice Address - Country:US
Practice Address - Phone:773-220-8384
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care