Organization
GOOD SHEPHERD MANOR INC
Active
Parent organization
GOOD SHEPHERD MANOR INC
Other names
Thomas Herbstritt House
Organization subpart
Yes
Provider details
NPI number
Legal business name
GOOD SHEPHERD MANOR INC
Authorized official
MR. BRUCE ROBERT FITZPATRICK (PRESIDENT)
(815) 472-3700
Entity
Organization
Contact information
Practice address
4003 N. ROUTES 1 & 17, MOMENCE, IL 60954-0260
(815) 472-3700
(815) 472-6086
Mailing address
PO BOX 260, MOMENCE, IL 60954-0260
(815) 472-3700
(815) 472-6086
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
0051466
IL
Other
Enumeration date
12/13/2011
Last updated
12/13/2011
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