Organization
GOOD SHEPHERD LUTHERAN HOME OF THE WEST
Active
Other names
Good Shepherd Communities
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY A. KACZMARSKI (CHIEF LEGAL AFFAIRS OFFICER)
(920) 206-4406
Entity
Organization
Contact information
Practice address
26489 RANCHO PKWY S, LAKE FOREST, CA 92630-8326
(949) 855-8056
(949) 600-6116
Mailing address
600 HOFFMANN DR, WATERTOWN, WI 53094-6223
(920) 261-3050
(920) 261-8441
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
CA
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
CO
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
OR
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
WA
Other
Enumeration date
01/15/2007
Last updated
04/29/2008
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