Provider Demographics
NPI:1134725419
Name:GOOD SHEPHERD HOME
Entity type:Organization
Organization Name:GOOD SHEPHERD HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTING
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-937-1801
Mailing Address - Street 1:725 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:FOSTORIA
Mailing Address - State:OH
Mailing Address - Zip Code:44830-3255
Mailing Address - Country:US
Mailing Address - Phone:419-937-1801
Mailing Address - Fax:419-937-9324
Practice Address - Street 1:725 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:FOSTORIA
Practice Address - State:OH
Practice Address - Zip Code:44830-3255
Practice Address - Country:US
Practice Address - Phone:419-937-1801
Practice Address - Fax:419-937-9324
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:0982N
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0114928Medicaid