Provider Demographics
NPI:1346311859
Name:GOOD SHEPHERDS HOME CARE INC
Entity Type:Organization
Organization Name:GOOD SHEPHERDS HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-686-8667
Mailing Address - Street 1:PO BOX 10999
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404-0999
Mailing Address - Country:US
Mailing Address - Phone:910-686-8667
Mailing Address - Fax:910-686-8667
Practice Address - Street 1:7114 HAVEN WAY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7141
Practice Address - Country:US
Practice Address - Phone:910-686-8667
Practice Address - Fax:910-686-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC3479251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6601573Medicaid