1245701150 NPI number — GOOD SHEPHERD ACQUISITION LLC

Table of content: (NPI 1245701150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245701150 NPI number — GOOD SHEPHERD ACQUISITION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SHEPHERD ACQUISITION LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245701150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 KERMIT DR STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37217-5102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-365-4424
Provider Business Mailing Address Fax Number:
615-365-7897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3280 NC HIGHWAY 69, STE. 11-A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAYESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28904-6953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-389-8106
Provider Business Practice Location Address Fax Number:
828-389-8484
Provider Enumeration Date:
12/17/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MCFADDIN-MILLS
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
SENIOR VP OF COMPLIANCE
Authorized Official Telephone Number:
615-365-4424

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)