Provider Demographics
NPI:1457559122
Name:GOOD SHEPHERD HOSPICE, INC.
Entity Type:Organization
Organization Name:GOOD SHEPHERD HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABELARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-257-9240
Mailing Address - Street 1:23210 CRENSHAW BLVD
Mailing Address - Street 2:SUITE 200B
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3146
Mailing Address - Country:US
Mailing Address - Phone:310-257-9240
Mailing Address - Fax:
Practice Address - Street 1:23210 CRENSHAW BLVD
Practice Address - Street 2:SUITE 200B
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3146
Practice Address - Country:US
Practice Address - Phone:310-257-9240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicare ID - Type UnspecifiedHOSPICE