Organization
GOOD SHEPHERD MANOR, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE ROBERT FITZPATRICK (PRESIDENT)
(815) 472-3700
Entity
Organization
Contact information
Practice address
4129 N STATE ROUTES 1 & 17, MOMENCE, IL 60954-0260
(815) 472-3700
(815) 472-6086
Mailing address
PO BOX 260, 4129 N STATE ROUTES 1 & 17, MOMENCE, IL 60954-0260
(815) 472-3700
(815) 472-6086
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
6-374
IL
311ZA0620X
Adult Care Home Facility
0002865
IL
Other
Enumeration date
03/17/2010
Last updated
03/17/2010
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