Provider Demographics
NPI:1871157875
Name:GOOD SHEPHERD HOSPICE CARE INC
Entity type:Organization
Organization Name:GOOD SHEPHERD HOSPICE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEJUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-893-3333
Mailing Address - Street 1:PO BOX 777851
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7851
Mailing Address - Country:US
Mailing Address - Phone:702-893-3333
Mailing Address - Fax:702-893-0960
Practice Address - Street 1:6070 S FORT APACHE RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5615
Practice Address - Country:US
Practice Address - Phone:702-839-1114
Practice Address - Fax:702-893-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based