Provider Demographics
NPI:1063394062
Name:SHEPHERD'S HOMECARE
Entity type:Organization
Organization Name:SHEPHERD'S HOMECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RIDER
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-536-8928
Mailing Address - Street 1:312 S 4TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3046
Mailing Address - Country:US
Mailing Address - Phone:502-536-8928
Mailing Address - Fax:
Practice Address - Street 1:5512 HALSTEAD AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2708
Practice Address - Country:US
Practice Address - Phone:502-536-8928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care