Provider Demographics
NPI:1063409803
Name:THE HOUSE OF THE GOOD SHEPHERD
Entity type:Organization
Organization Name:THE HOUSE OF THE GOOD SHEPHERD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-684-5734
Mailing Address - Street 1:798 WILLOW GROVE ST
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1718
Mailing Address - Country:US
Mailing Address - Phone:908-684-5900
Mailing Address - Fax:908-979-7038
Practice Address - Street 1:798 WILLOW GROVE ST
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1718
Practice Address - Country:US
Practice Address - Phone:908-684-5900
Practice Address - Fax:908-979-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ95C000310400000X
NJ032101314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4506812Medicaid
NJ4506804Medicaid
NJ4506804Medicaid