Provider Demographics
NPI:1992131635
Name:GOOD SHEPHERD HOSPICE
Entity type:Organization
Organization Name:GOOD SHEPHERD HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRIANNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-465-6300
Mailing Address - Street 1:110 BI COUNTY BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-3943
Mailing Address - Country:US
Mailing Address - Phone:631-828-7415
Mailing Address - Fax:631-828-7494
Practice Address - Street 1:110 BI COUNTY BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3943
Practice Address - Country:US
Practice Address - Phone:631-828-7415
Practice Address - Fax:631-828-7494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SHEPHERD HOSPICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-25
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative MedicineGroup - Single Specialty