1649605437 NPI number — GOOD SHEPHERD IN-HOME SENIOR CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649605437 NPI number — GOOD SHEPHERD IN-HOME SENIOR CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD SHEPHERD IN-HOME SENIOR CARE
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:
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:
1649605437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 FOREST HILLS BLVD
Provider Second Line Business Mailing Address:
133
Provider Business Mailing Address City Name:
BELLA VISTA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72715-3016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-248-1475
Provider Business Mailing Address Fax Number:
479-203-7289

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 FOREST HILLS BLVD
Provider Second Line Business Practice Location Address:
133
Provider Business Practice Location Address City Name:
BELLA VISTA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72715-3016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-248-1475
Provider Business Practice Location Address Fax Number:
479-203-7289
Provider Enumeration Date:
09/11/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
CHIP
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
479-248-1475

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  811006810 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com