Provider Demographics
NPI:1487653457
Name:THE GOOD SHEPHERD HOME FOR THE AGED
Entity Type:Organization
Organization Name:THE GOOD SHEPHERD HOME FOR THE AGED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:STOFAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-228-5200
Mailing Address - Street 1:622 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3343
Mailing Address - Country:US
Mailing Address - Phone:419-289-3523
Mailing Address - Fax:419-281-0656
Practice Address - Street 1:622 CENTER ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3343
Practice Address - Country:US
Practice Address - Phone:419-289-3523
Practice Address - Fax:419-281-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH000472N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0025850Medicaid
OH0025850Medicaid