Provider Demographics
NPI:1568148179
Name:GOOD SHEPHERD DDD SERVICES LLC
Entity Type:Organization
Organization Name:GOOD SHEPHERD DDD SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RAGAE
Authorized Official - Middle Name:W
Authorized Official - Last Name:WASSEF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-930-5687
Mailing Address - Street 1:725 VALLEY BROOK AVE
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2030
Mailing Address - Country:US
Mailing Address - Phone:201-933-0711
Mailing Address - Fax:201-933-0611
Practice Address - Street 1:725 VALLEY BROOK AVE
Practice Address - Street 2:
Practice Address - City:LYNDHURST
Practice Address - State:NJ
Practice Address - Zip Code:07071-2030
Practice Address - Country:US
Practice Address - Phone:201-933-0711
Practice Address - Fax:201-933-0611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities