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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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