Provider Demographics
NPI:1487342424
Name:GOOD SHEPHERD PSYCHIATRIC & MEDICAL CENTER INC
Entity type:Organization
Organization Name:GOOD SHEPHERD PSYCHIATRIC & MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHANTALE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-459-4164
Mailing Address - Street 1:9050 PINES BLVD # 428
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PNES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6455
Mailing Address - Country:US
Mailing Address - Phone:954-271-5676
Mailing Address - Fax:954-271-5779
Practice Address - Street 1:9050 PINES BLVD STE 425-428
Practice Address - Street 2:
Practice Address - City:PEMBROKE PNES
Practice Address - State:FL
Practice Address - Zip Code:33024-6455
Practice Address - Country:US
Practice Address - Phone:954-271-5676
Practice Address - Fax:954-271-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty