Provider Demographics
NPI:1689684433
Name:GOOD SHEPHERD HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:GOOD SHEPHERD HOME HEALTH AGENCY, INC.
Other - Org Name:HOME HEALTH CARE 2000 - LAKE CHARLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-562-1140
Mailing Address - Street 1:1901 OAK PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-8915
Mailing Address - Country:US
Mailing Address - Phone:337-562-1140
Mailing Address - Fax:337-562-1142
Practice Address - Street 1:2013 OAK PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-7833
Practice Address - Country:US
Practice Address - Phone:337-439-5444
Practice Address - Fax:337-436-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA337251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1402524Medicaid
LA1402524Medicaid
LA197265Medicare Oscar/Certification