Provider Demographics
NPI:1417369158
Name:GOOD SHEPHERD RESIDENTIAL CARE, LLC
Entity Type:Organization
Organization Name:GOOD SHEPHERD RESIDENTIAL CARE, LLC
Other - Org Name:INLAND EMPIRE HOME HEALTH CARE AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NWAMU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-990-0450
Mailing Address - Street 1:238 N RIVERSIDE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-5972
Mailing Address - Country:US
Mailing Address - Phone:909-990-0450
Mailing Address - Fax:909-990-0479
Practice Address - Street 1:238 N RIVERSIDE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5972
Practice Address - Country:US
Practice Address - Phone:909-990-0450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health