Good Shepherd Home Healthcare Agency Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

009686 Issued in TX

Legal business name

GOOD SHEPHERD HOME HEALTHCARE AGENCY INC.

Doing business as

Good Shepherd Home Healthcare Agency

Practice address

811 S Central Expy Ste 531
Richardson, TX 75080-7426

Phone

(972) 470-0440

Fax

(972) 470-0307

NPI assigned

Dec 18, 2006

Last updated

May 16, 2018By 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

Fidelis Simo

Title

Cfo

Phone

(972) 470-0440

Specialties & licenses 3

Addresses

Other names 1

• Good Shepherd Home Healthcare Agency Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386707685. Details of each certification follow.

• CCN 677817 Home health agency · Active · Details

Home health agency certification: CCN 677817

Legal name

GOOD SHEPHERD HOME HEALTHCARE AGENCY INC.

Doing business as

GOOD SHEPHERD HOME HEALTHCARE AGENCY

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Mar 1, 2006

Last certification

Nov 17, 2020

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Sep 9, 2004 in TX

Enrollment address

811 S. Central Expy
Suite 444
Richardson, TX 75080

Listed as

Good Shepherd Home Healthcare AgencyCCN 677817 · All quality measures

Ownership

Proprietary

Certified

Mar 1, 2006

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526428800000",
    "number": "1386707685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 S CENTRAL EXPY STE 531",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750807426",
            "telephone_number": "972-470-0440",
            "fax_number": "972-470-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 S CENTRAL EXPY STE 531",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750807426",
            "telephone_number": "972-470-0440",
            "fax_number": "972-470-0307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HOME HEALTHCARE AGENCY INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2018-05-16",
        "status": "A",
        "authorized_official_last_name": "SIMO",
        "authorized_official_first_name": "FIDELIS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "972-470-0440"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "TX",
            "license": "009686",
            "primary": true
        },
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "TX",
            "license": "009686",
            "primary": false
        },
        {
            "code": "3747P1801X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Technician, Personal Care Attendant",
            "state": "TX",
            "license": "009686",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Home Healthcare Agency",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Shepherd Home Healthcare Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Gonzalez
• Jose Gonzalez
• Keri Gonzalez
• Tammy Lee Gonzalez, PHARMD
• Valerie Gonzalez, PTA
• Goodlyfe Care LLC
• Cynthia Diane Goodman, M.D.
• Curtis Goodwin
• Lexus Farrin Goodwin
• Morris Gottlieb, M.D.

• Home Health Agency in Richardson, TX
• Providers in Richardson, TX by specialty
• Home Health Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.