Provider Demographics
NPI:1346295029
Name:GOOD SHEPHERD HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:GOOD SHEPHERD HEALTH CARE SYSTEM
Other - Org Name:VANGE JOHN MEMORIAL HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-667-3400
Mailing Address - Street 1:610 NW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838
Mailing Address - Country:US
Mailing Address - Phone:541-667-3400
Mailing Address - Fax:541-667-3454
Practice Address - Street 1:610 NW 11TH ST
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838
Practice Address - Country:US
Practice Address - Phone:541-667-3400
Practice Address - Fax:541-667-3454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORB80023OtherBLUE CROSS
WA7260409OtherWASHINGTON DSHS
WA11096OtherWASHINGTON L&I
WA3001302OtherWASHINGTON DSHS
OR298808Medicaid
OR298808Medicaid
OR381543Medicare ID - Type UnspecifiedHOSPICE MCR