Organization
GOOD SHEPHERD HOME, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH A CAPTAIN RN NHA (EXECUTIVE DIRECTOR)
(920) 833-6856
Entity
Organization
Contact information
Practice address
607 E BRONSON RD, SEYMOUR, WI 54165-1040
(920) 833-6856
(920) 833-1846
Mailing address
607 BRONSON ROAD, SEYMOUR, WI 54165
(920) 833-6856
(920) 833-1846
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
1924
WI
314000000X
Skilled Nursing Facility
Primary
2659
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20108500
—
WI
Enumeration date
03/02/2006
Last updated
04/25/2013
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