Provider Demographics
NPI:1629015078
Name:GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC
Entity Type:Organization
Organization Name:GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC
Other - Org Name:GOOD SHEPHERD HOME RAKER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-776-3130
Mailing Address - Street 1:850 S 5TH ST
Mailing Address - Street 2:GOOD SHEPHERD PLAZA
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3308
Mailing Address - Country:US
Mailing Address - Phone:610-776-8303
Mailing Address - Fax:610-778-9272
Practice Address - Street 1:601 SAINT JOHN ST
Practice Address - Street 2:CONRAD W RAKER CENTER
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3233
Practice Address - Country:US
Practice Address - Phone:610-776-3199
Practice Address - Fax:610-776-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA070802314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017915090007Medicaid
PA1007608230006Medicaid