Organization
FRIENDS OF GOOD SHEPHERD MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JACKIE BRENDA BOWLING (EXECUTIVE DIRECTOR)
(740) 289-2861
Entity
Organization
Contact information
Practice address
374 GOOD MANOR RD., LUCASVILLE, OH 45648-1029
(740) 289-2861
(740) 289-3916
Mailing address
PO BOX 1029, LUCASVILLE, OH 45648-1029
(740) 289-2861
(740) 289-3916
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
6610055
OH
315P00000X
Intellectual Disabilities Intermediate Care Facility
6610153
OH
315P00000X
Intellectual Disabilities Intermediate Care Facility
6610306
OH
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
6600173
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0830364
—
OH
Enumeration date
05/07/2007
Last updated
02/11/2009
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