Provider Demographics
NPI:1841365723
Name:GOOD SHEPHERD HEALTHCARE LLC
Entity type:Organization
Organization Name:GOOD SHEPHERD HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENIGNO
Authorized Official - Middle Name:MANAHAN
Authorized Official - Last Name:TUAZON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-380-1060
Mailing Address - Street 1:2451 SOUTH BUFFALO DRIVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2749
Mailing Address - Country:US
Mailing Address - Phone:702-380-1060
Mailing Address - Fax:702-380-1081
Practice Address - Street 1:2451 SOUTH BUFFALO DRIVE SUITE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-2749
Practice Address - Country:US
Practice Address - Phone:702-380-1060
Practice Address - Fax:702-380-1081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2251C2600X, 2251G0304X, 2251N0400X, 2251X0800X, 225200000X, 225B00000X, 225X00000X, 2278P1005X, 2279P1005X, 235Z00000X, 1041C0700X, 133NN1002X, 163WC3500X, 224Z00000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251C2600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistCardiopulmonaryGroup - Multi-Specialty
Not Answered2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Multi-Specialty
Not Answered2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurologyGroup - Multi-Specialty
Not Answered2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Not Answered225B00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPulmonary Function TechnologistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered2278P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedPulmonary RehabilitationGroup - Multi-Specialty
Not Answered2279P1005XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredPulmonary RehabilitationGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Not Answered133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
Not Answered163WC3500XNursing Service ProvidersRegistered NurseCardiac RehabilitationGroup - Multi-Specialty
Not Answered224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV294506Medicare ID - Type UnspecifiedOUTPATIENT REHAB FACILITY