Good Shepherd Lutheran Home of the West

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

GOOD SHEPHERD LUTHERAN HOME OF THE WEST

Doing business as

Good Shepherd Communities

Practice address

26489 Rancho Pkwy S
Lake Forest, CA 92630-8326

Phone

(949) 855-8056

Fax

(949) 600-6116

NPI assigned

Jan 15, 2007

Last updated

Apr 29, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jeffrey A. Kaczmarski

Title

Chief Legal Affairs Officer

Phone

(920) 206-4406

Specialties & licenses 4

Addresses

Other names 1

• Good Shepherd Communities Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209427200000",
    "number": "1194876359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 HOFFMANN DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530946223",
            "telephone_number": "920-261-3050",
            "fax_number": "920-261-8441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26489 RANCHO PKWY S",
            "city": "LAKE FOREST",
            "state": "CA",
            "postal_code": "926308326",
            "telephone_number": "949-855-8056",
            "fax_number": "949-600-6116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD LUTHERAN HOME OF THE WEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2008-04-29",
        "status": "A",
        "authorized_official_last_name": "KACZMARSKI",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CHIEF LEGAL AFFAIRS OFFICER",
        "authorized_official_telephone_number": "920-206-4406",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CA",
            "license": null,
            "primary": true
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "CO",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OR",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Communities",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Leslie Gonzalez-Martinez
• Andrea Guadalupe Gonzalez, APCC
• Edna M Gonzalez
• Marbelt Gonzalez
• Otoniel Gonzalez, N.P.
• Steven Marcus Goodman, L.AC.
• John Maxwell Gooing, DC
• Jason Michael Gorden
• Bryce Jay Allen Gordon, ATC, MA, CES
• Arezou Goshtasbi, D.D.S.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lake Forest, CA
• Providers in Lake Forest, CA by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.