Provider Demographics
NPI:1689826570
Name:GOOD SHEPHERD FAIRVIEW HOME INC
Entity Type:Organization
Organization Name:GOOD SHEPHERD FAIRVIEW HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ULYSSES
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-724-2477
Mailing Address - Street 1:80 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1132
Mailing Address - Country:US
Mailing Address - Phone:607-724-2477
Mailing Address - Fax:
Practice Address - Street 1:80 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1132
Practice Address - Country:US
Practice Address - Phone:607-724-2477
Practice Address - Fax:607-724-0957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030E005310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00474699Medicaid
NY335527Medicare Oscar/Certification