Provider Demographics
NPI:1134959844
Name:GOOD SHEPHERD PERSONAL CARE OF ARKANSAS LLC
Entity type:Organization
Organization Name:GOOD SHEPHERD PERSONAL CARE OF ARKANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBLEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-348-4233
Mailing Address - Street 1:PO BOX 1497
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71221-1497
Mailing Address - Country:US
Mailing Address - Phone:318-450-2300
Mailing Address - Fax:318-283-0210
Practice Address - Street 1:101 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:AR
Practice Address - Zip Code:71646-3256
Practice Address - Country:US
Practice Address - Phone:870-831-9533
Practice Address - Fax:318-283-0210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care