Provider Demographics
NPI:1629588728
Name:GOOD SHEPHERD HOUSE, INC
Entity Type:Organization
Organization Name:GOOD SHEPHERD HOUSE, INC
Other - Org Name:GOOD SHEPHERD HOUSE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-557-1722
Mailing Address - Street 1:129 PEBBLE BEACH LN
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5958
Mailing Address - Country:US
Mailing Address - Phone:757-344-7261
Mailing Address - Fax:757-818-8619
Practice Address - Street 1:728 OLD BUCKROE RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-1533
Practice Address - Country:US
Practice Address - Phone:800-557-1722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2017-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2668253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care