FRIENDS OF GOOD SHEPHERD MANOR (NPI# 1912110925) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912110925 |
| Entity Type | Organization |
| Organization Name | FRIENDS OF GOOD SHEPHERD MANOR |
| Practice Address |
374 Good Manor Rd. Lucasville OH 45648-1029 |
| Mailing Address |
Po Box 1029 Lucasville OH 45648-1029 |
| Practice Telephone | 7402892861 |
| Practice Fax Number | 7402893916 |
| Mailing Telephone | 7402892861 |
| Mailing Fax Number | 7402893916 |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2009-02-11 |
| Authorized Official Name | MS. JACKIE BRENDA BOWLING (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 7402892861 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | 6610055 | OH | Nursing & Custodial Care Facilities |
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | 6610153 | OH | Nursing & Custodial Care Facilities |
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | 6610306 | OH | Nursing & Custodial Care Facilities |
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6600173 | OH | Residential Treatment Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0830364 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134368459 | Friends of Good Shepherd Manor | Intermediate Care Facility, Mentally Retarded | 374 Good Manor Rd, Lucasville, OH 45648 | 2009-02-10 |
| 1275704546 | Friends of Good Shepherd Manor | Intermediate Care Facility, Mentally Retarded | 374 Good Manor Rd., Lucasville, OH 45648 | 2008-03-14 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | FRIENDS OF GOOD SHEPHERD MANOR HOUSING ORGANIZATION, INC. | 374 Good Manor Rd, Lucasville, OH 45648-9606 |
| Street Address |
374 GOOD MANOR RD. |
| City | LUCASVILLE |
| State | OH |
| Zip Code | 45648-1029 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275704546 | Friends of Good Shepherd Manor | Intermediate Care Facility, Mentally Retarded | 374 Good Manor Rd., Lucasville, OH 45648 | 2008-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558762138 | Cobra Pharmacy, LLC | Pharmacy | 37 C Lucasville-minford Road, Lucasville, OH 45648 | 2014-09-15 |
| 1366842221 | Premier Therapy & Health Centers, Inc. | Clinic/Center | 10606 U.S. 23, Lucasville, OH 45648 | 2014-08-28 |
| 1720495260 | Stephanie Jordan | Contractor | 9500 Campcreek Rd, Lucasville, OH 45648 | 2014-07-16 |
| 1851630255 | Amy D Reeder | Occupational Therapy Assistant | 10098a Big Bearcreek, Lucasville, OH 45648 | 2013-02-05 |
| 1033458567 | Christopher E Holbrook Sr. | Durable Medical Equipment & Medical Supplies | 10324 Us Rte 23, Lucasville, OH 45648 | 2013-02-04 |
| 1366735953 | Health Maintenance Partners, Inc. | Clinic/Center | 10701 Us 23 South, Lucasville, OH 45648 | 2011-05-16 |
| 1154552271 | Dianne N Bragdon | Licensed Practical Nurse | 115 Borders Road, Lucasville, OH 45648 | 2009-08-06 |
| 1134368459 | Friends of Good Shepherd Manor | Intermediate Care Facility, Mentally Retarded | 374 Good Manor Rd, Lucasville, OH 45648 | 2009-02-10 |
| 1366688897 | Scioto Ambulance District | Ambulance | 7106 Big Bear Creek Road, Lucasville, OH 45648 | 2009-01-06 |
| 1831311422 | Cheryl Annette Frazier | Licensed Practical Nurse | 763 Dewey Ext, Lucasville, OH 45648 | 2007-05-03 |
| Find all providers in zip 45648 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366043341 | Denise Szabados | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 802 Valley Dr, Amherst, OH 44001-2041 | 2020-11-05 |
| 1093316374 | Collene Marie Hill | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 06605 Cr 8, Bryan, OH 43506-4350 | 2020-11-04 |
| 1467052050 | Kathryn Mooers Howitt | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 374 Woodlawn Reserve Rd, Akron, OH 44305-3959 | 2020-11-01 |
| 1679173629 | The Resource Empowerment Center LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3895 S Main St, Akron, OH 44319-3630 | 2020-10-29 |
| 1104426667 | Highest Expectations LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 25 W South St, Lebanon, OH 45036-2127 | 2020-10-26 |
| 1982203964 | Family Care Supportive Living LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5012 Saint Aubin Dr, Toledo, OH 43615-5913 | 2020-10-21 |
| 1699374082 | Pamela Wilkes | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 116 Washburn Rd, Tallmadge, OH 44278-2612 | 2020-10-18 |
| 1073111654 | Mary V Byrd | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 37 Sterling Rd, Marietta, OH 45750 | 2020-10-15 |
| 1558969477 | Caryl Westgerdes | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 3064 Eagle Cove Dr, Ripley, OH 45167-9683 | 2020-10-13 |
| 1972101210 | Nakia Sullins | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 6033 Bear Creek Dr Apt 210, Bedford Heights, OH 44146-2907 | 2020-10-09 |
| Find all providers with the same taxonomy | ||||
| City | LUCASVILLE |
| Zip Code | 45648 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.