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Organization

GOOD SHEPHERD CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN ANTOGNOLI ED.D. (CHIEF EXECUTIVE OFFICER)
(570) 702-8360
Entity
Organization

Contact information

Practice address
1327 WYOMING AVE, SCRANTON, PA 18509-2861
(570) 702-8360
(570) 702-8623
Mailing address
1327 WYOMING AVE, SCRANTON, PA 18509-2861
(570) 702-8360
(570) 702-8623

Taxonomy

Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
000351062
PA
251S00000X
Community/Behavioral Health Agency
000351062
PA
261Q00000X
Clinic/Center
000351062
PA
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
000351062
PA
261QM0855X
Adolescent and Children Mental Health Clinic/Center
000351062
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1007283070003
PA
Enumeration date
02/27/2007
Last updated
09/15/2010
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