Provider Demographics
NPI:1568004976
Name:GOOD SHEPHERD INSTITUTE OF THE BLUEGRASS
Entity Type:Organization
Organization Name:GOOD SHEPHERD INSTITUTE OF THE BLUEGRASS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURRY
Authorized Official - Suffix:
Authorized Official - Credentials:CLTC
Authorized Official - Phone:502-244-6820
Mailing Address - Street 1:622 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-5121
Mailing Address - Country:US
Mailing Address - Phone:502-303-1996
Mailing Address - Fax:502-562-2500
Practice Address - Street 1:307 W DIXIE AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1701
Practice Address - Country:US
Practice Address - Phone:502-632-3249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY RENEWAL PROJECT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-17
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)