Provider Demographics
NPI:1477591014
Name:GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC
Entity Type:Organization
Organization Name:GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC
Other - Org Name:GOOD SHEPHERD HOME-BETHLEHEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCECFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:CONFALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-776-3303
Mailing Address - Street 1:850 S 5TH ST
Mailing Address - Street 2:GOOD SHEPHERD PLAZA
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3308
Mailing Address - Country:US
Mailing Address - Phone:610-776-8303
Mailing Address - Fax:610-778-9272
Practice Address - Street 1:2855 SCHOENERSVILLE RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7306
Practice Address - Country:US
Practice Address - Phone:610-807-5600
Practice Address - Fax:610-882-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA12650202313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017915090001Medicaid
PA0017915090001Medicaid