GOOD SHEPHERD MANOR GROUPS HOMES INC NPI 1689998700

NPI Information

NPI: 1689998700
Provider Name: GOOD SHEPHERD MANOR GROUPS HOMES, INC
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
4129 N STATE ROUTES 1 & 17
MOMENCE, IL
ZIP 60954
Phone: (815) 472-3700
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GOOD SHEPHERD MANOR GROUPS HOMES, INC is a community based residential treatment facility, intellectual and/or developmental disabilities in Momence, IL. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. GOOD SHEPHERD MANOR GROUPS HOMES, INC NPI is 1689998700. The provider is registered as an organization entity type.

The provider's business location address is:

4129 N STATE ROUTES 1 & 17
MOMENCE, IL
ZIP 60954
Phone: (815) 472-3700
Fax: (815) 472-6086

The provider's authorized official is Bruce Robert Fitzpatrick .
The authorized official title is President and has the following contact phone number (815) 472-3700.

The enumeration date for this NPI number is 3/18/2010 and was last updated on 3/18/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities	0041913	ILLINOIS	No
2	315P00000X	Intermediate Care Facility, Intellectual Disabilities	41905	ILLINOIS	No
3	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	96S015	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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