Provider Demographics
NPI:1477229789
Name:GREAT SHEPHERD BEHAVORIAL HEALTH CENTER
Entity Type:Organization
Organization Name:GREAT SHEPHERD BEHAVORIAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:C
Authorized Official - Last Name:EMELUMBA
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN, PMHNP-BC
Authorized Official - Phone:551-247-8105
Mailing Address - Street 1:354 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-1412
Mailing Address - Country:US
Mailing Address - Phone:973-573-1648
Mailing Address - Fax:
Practice Address - Street 1:354 AVENUE C
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-1412
Practice Address - Country:US
Practice Address - Phone:551-247-8105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty