Provider Demographics
NPI:1942532114
Name:GOOD SHEPHERD VILLAGE AT ENDWELL, INC.
Entity Type:Organization
Organization Name:GOOD SHEPHERD VILLAGE AT ENDWELL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ULYSSES
Authorized Official - Middle Name:SAM
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-584-3227
Mailing Address - Street 1:80 FAIRVIEW AVENU
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:607-724-0957
Practice Address - Street 1:32 VILLAGE DRIVE
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1062
Practice Address - Country:US
Practice Address - Phone:607-757-3100
Practice Address - Fax:607-757-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-12
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
NY0363301N314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03247849Medicaid
NY335859Medicare Oscar/Certification