Provider Demographics
NPI:1740022763
Name:GOOD SHEPHERD HOME CARE LLC
Entity type:Organization
Organization Name:GOOD SHEPHERD HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO & NON-NURSE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-409-2928
Mailing Address - Street 1:765 WESTMINSTER ST STE 304
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-4082
Mailing Address - Country:US
Mailing Address - Phone:401-409-2928
Mailing Address - Fax:401-409-2941
Practice Address - Street 1:765 WESTMINSTER ST STE 304
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4082
Practice Address - Country:US
Practice Address - Phone:401-409-2928
Practice Address - Fax:401-409-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)