Provider Demographics
NPI:1851554190
Name:GOOD SHEPHERD NURSING AND SENIOR CARE INC
Entity Type:Organization
Organization Name:GOOD SHEPHERD NURSING AND SENIOR CARE INC
Other - Org Name:GOOD SHEPHERD HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:POKU - KWATENG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-772-9342
Mailing Address - Street 1:6000 STEVENSON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3526
Mailing Address - Country:US
Mailing Address - Phone:703-772-9342
Mailing Address - Fax:571-248-8120
Practice Address - Street 1:6000 STEVENSON AVE STE 301
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3526
Practice Address - Country:US
Practice Address - Phone:703-772-9342
Practice Address - Fax:571-248-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health