Provider Demographics
NPI:1639955198
Name:GOOD SHEPARD COMMUNITY HEALTH SERVICE
Entity Type:Organization
Organization Name:GOOD SHEPARD COMMUNITY HEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-713-0464
Mailing Address - Street 1:217 BLUE JACKET CIR
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8049
Mailing Address - Country:US
Mailing Address - Phone:240-712-0464
Mailing Address - Fax:
Practice Address - Street 1:217 BLUE JACKET CIR
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-8049
Practice Address - Country:US
Practice Address - Phone:240-713-0464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health