Provider Demographics
NPI:1821001512
Name:GOOD SHEPHERD HOME HEALTHCARE,INC.
Entity Type:Organization
Organization Name:GOOD SHEPHERD HOME HEALTHCARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ESPERANZA
Authorized Official - Middle Name:PRESA
Authorized Official - Last Name:FORONDA
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:757-306-0800
Mailing Address - Street 1:3617 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-3418
Mailing Address - Country:US
Mailing Address - Phone:757-306-0800
Mailing Address - Fax:
Practice Address - Street 1:3617 VIRGINIA BEACH BLVD.
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-306-0800
Practice Address - Fax:757-306-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO347251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA497609Medicare ID - Type Unspecified