Provider Demographics
NPI:1578510368
Name:MARYANN OBI
Entity Type:Organization
Organization Name:MARYANN OBI
Other - Org Name:GOOD SHEPARD HOME HEALTH AGENCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST ADMINISTRATOR/CFO
Authorized Official - Prefix:
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:OBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-581-6313
Mailing Address - Street 1:1065 DONIPHAN PARK CIRCLE
Mailing Address - Street 2:SUIT B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-2215
Mailing Address - Country:US
Mailing Address - Phone:915-581-6313
Mailing Address - Fax:915-842-0533
Practice Address - Street 1:1065 DONIPHAN PARK CIRCLE
Practice Address - Street 2:SUIT B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-2215
Practice Address - Country:US
Practice Address - Phone:915-581-6313
Practice Address - Fax:915-842-0533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009593251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457948Medicare Oscar/Certification