GOOD SHEPHERD MANOR INC NPI 1841568284

NPI Information

NPI: 1841568284
Provider Name: GOOD SHEPHERD MANOR INC

Other Name: THOMAS LOMBARD HOUSE

Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
4129A N. STATE ROUTES 1 & 17
MOMENCE, IL
ZIP 60954
Phone: (815) 472-3700
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GOOD SHEPHERD MANOR INC is an intermediate care facility mentally retarded in Momence, IL. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. GOOD SHEPHERD MANOR INC NPI is 1841568284. The provider is registered as an organization entity type.
The provider Other Name Is Thomas Lombard House.

The provider's business location address is:

4129A N. STATE ROUTES 1 & 17
MOMENCE, IL
ZIP 60954-260
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 12/13/2011 and was last updated on 12/13/2011.

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	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities		0051474	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

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