Provider Demographics
NPI:1972503779
Name:GOOD SHEPHERD REHABILITATION AND NURSING CENTER
Entity Type:Organization
Organization Name:GOOD SHEPHERD REHABILITATION AND NURSING CENTER
Other - Org Name:GOOD SHEPHERD HEALTH CARE CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:NUNN
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MHA
Authorized Official - Phone:603-532-8762
Mailing Address - Street 1:20 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:JAFFREY
Mailing Address - State:NH
Mailing Address - Zip Code:03452-6631
Mailing Address - Country:US
Mailing Address - Phone:603-532-8762
Mailing Address - Fax:603-532-6057
Practice Address - Street 1:20 PLANTATION DR
Practice Address - Street 2:
Practice Address - City:JAFFREY
Practice Address - State:NH
Practice Address - Zip Code:03452-6631
Practice Address - Country:US
Practice Address - Phone:603-532-8762
Practice Address - Fax:603-532-6057
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW HAMPSHIRE CATHOLIC CHARITIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-22
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH01621314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30003252Medicaid
NH305072Medicare Oscar/Certification