Organization
HOSPICE OF THE GOOD SHEPHERD, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY BOON (EXECUTIVE DIRECTOR)
(617) 969-6130
Entity
Organization
Contact information
Practice address
160 WELLS AVE, NEWTON, MA 02459-3302
(617) 969-6130
(617) 928-1450
Mailing address
160 WELLS AVE, NEWTON, MA 02459-3302
(617) 969-6130
(617) 928-1450
Taxonomy
Speciality
Code
Description
License number
State
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
251G00000X
Community Based Hospice Care Agency
Primary
7205
MA
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110024344A
—
MA
05
—
110024344B
—
MA
Enumeration date
07/27/2005
Last updated
11/30/2020
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