1477591014 NPI number — GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC

Table of content: (NPI 1477591014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477591014 NPI number — GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SHEPHERD HOME LONG TERM CARE FACILITY, INC
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:
1477591014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 S 5TH ST
Provider Second Line Business Mailing Address:
GOOD SHEPHERD PLAZA
Provider Business Mailing Address City Name:
ALLENTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18103-3308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-776-8303
Provider Business Mailing Address Fax Number:
610-778-9272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2855 SCHOENERSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18017-7306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-807-5600
Provider Business Practice Location Address Fax Number:
610-882-0155
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONFALONE
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
C
Authorized Official Title or Position:
VP FINANCECFO
Authorized Official Telephone Number:
610-776-3303

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  12650202 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0017915090001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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