Provider Demographics
NPI:1386707685
Name:GOOD SHEPHERD HOME HEALTHCARE AGENCY INC.
Entity type:Organization
Organization Name:GOOD SHEPHERD HOME HEALTHCARE AGENCY INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:FIDELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-470-0440
Mailing Address - Street 1:811 S CENTRAL EXPY STE 531
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-7426
Mailing Address - Country:US
Mailing Address - Phone:972-470-0440
Mailing Address - Fax:972-470-0307
Practice Address - Street 1:811 S CENTRAL EXPY STE 531
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-7426
Practice Address - Country:US
Practice Address - Phone:972-470-0440
Practice Address - Fax:972-470-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009686251E00000X, 251J00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677817Medicare ID - Type Unspecified