Provider Demographics
NPI:1992985733
Name:GOOD SHEPHERD AMBULANCE LLC
Entity type:Organization
Organization Name:GOOD SHEPHERD AMBULANCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANADOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-287-5200
Mailing Address - Street 1:109 AGOSTINO RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-2550
Mailing Address - Country:US
Mailing Address - Phone:626-287-5200
Mailing Address - Fax:
Practice Address - Street 1:109 AGOSTINO RD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-2550
Practice Address - Country:US
Practice Address - Phone:626-287-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-09
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance