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Organization
FRIENDS OF GOOD SHEPHERD MANOR
Active
Organization
FRIENDS OF GOOD SHEPHERD MANOR
Active
Other names
Good Shepherd Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVE PHIPPS (INTERIM CHIEF EXECUTIVE DIRECTOR)
(877) 885-2861
Entity
Organization
Contact information
Practice address
374 GOOD MANOR RD., LUCASVILLE, OH 45648
(187) 788-5286
Mailing address
374 GOOD MANOR ROAD, LUCASVILLE, OH 45648
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0850477
—
OH
Enumeration date
03/14/2008
Last updated
02/04/2009
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