Provider Demographics
NPI:1992946073
Name:GOOD SHEPHERD ASSISTED LIVING
Entity type:Organization
Organization Name:GOOD SHEPHERD ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER -SOLE PROPRIETER
Authorized Official - Prefix:MR
Authorized Official - First Name:FLORIN
Authorized Official - Middle Name:IONEL
Authorized Official - Last Name:HUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-995-4447
Mailing Address - Street 1:1712 BRASELTON HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-2813
Mailing Address - Country:US
Mailing Address - Phone:770-995-4447
Mailing Address - Fax:770-995-4446
Practice Address - Street 1:1712 BRASELTON HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-2813
Practice Address - Country:US
Practice Address - Phone:770-995-4447
Practice Address - Fax:770-995-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2009000738311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home