Provider Demographics
NPI:1912183583
Name:THE GOOD SHEPHERD ASSISTED LIVING
Entity Type:Organization
Organization Name:THE GOOD SHEPHERD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:DENIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-932-0084
Mailing Address - Street 1:1707 W OAK ST
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4079
Mailing Address - Country:US
Mailing Address - Phone:407-932-0084
Mailing Address - Fax:408-933-0089
Practice Address - Street 1:1707 W OAK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4079
Practice Address - Country:US
Practice Address - Phone:407-932-0084
Practice Address - Fax:408-933-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility