Provider Demographics
NPI:1942508304
Name:GOOD SHEPERD REBILITATION
Entity Type:Organization
Organization Name:GOOD SHEPERD REBILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DE
Authorized Official - Last Name:GUZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:702-722-6408
Mailing Address - Street 1:7455 W WASHINGTON AVE
Mailing Address - Street 2:STE. 185
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4337
Mailing Address - Country:US
Mailing Address - Phone:702-722-6408
Mailing Address - Fax:702-722-6458
Practice Address - Street 1:7455 W WASHINGTON AVE
Practice Address - Street 2:STE. 185
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4337
Practice Address - Country:US
Practice Address - Phone:702-722-6408
Practice Address - Fax:702-722-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities