Provider Demographics
NPI:1487688719
Name:GOOD SHEPHERD HEALTHCARE, LLC
Entity Type:Organization
Organization Name:GOOD SHEPHERD HEALTHCARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-650-3766
Mailing Address - Street 1:11259 E VIA LINDA # 100-997
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-4076
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:
Practice Address - Street 1:7455 W WASHINGTON AVE
Practice Address - Street 2:STE.115
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4337
Practice Address - Country:US
Practice Address - Phone:702-893-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV294506Medicare ID - Type Unspecified