NPIMap

Organization Active NPI

Good Shepherd Manor Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Momence, IL
National Provider Identifier
1750659199
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
0051466 Issued in IL
Legal business name
GOOD SHEPHERD MANOR INC
Practice address
4003 N. Routes 1 & 17
Momence, IL 60954-0260
Phone
(815) 472-3700
Fax
(815) 472-6086
NPI assigned
Dec 13, 2011
Last updated
Dec 13, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
GOOD SHEPHERD MANOR INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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

Authorized official

Name
Mr. Bruce Robert Fitzpatrick
Title
President
Phone
(815) 472-3700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 0051466 IL Primary

Addresses

Primary practice location

4003 N. Routes 1 & 17
Momence, IL 60954-0260

Mailing address

PO Box 260
Momence, IL 60954-0260
Phone (815) 472-3700

Other names 1

  • Thomas Herbstritt House Other name

National Provider Directory

National Provider Directory
Tax ID family
Good Shepherd Manor Inc3 organizations share this tax ID, including this one
Part of
Good Shepherd Manor Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1323734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323734400000",
    "number": "1750659199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 260",
            "city": "MOMENCE",
            "state": "IL",
            "postal_code": "609540260",
            "telephone_number": "815-472-3700",
            "fax_number": "815-472-6086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4003 N. ROUTES 1 & 17",
            "city": "MOMENCE",
            "state": "IL",
            "postal_code": "609540260",
            "telephone_number": "815-472-3700",
            "fax_number": "815-472-6086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD MANOR INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GOOD SHEPHERD MANOR INC",
        "enumeration_date": "2011-12-13",
        "last_updated": "2011-12-13",
        "status": "A",
        "authorized_official_last_name": "FITZPATRICK",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-472-3700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "IL",
            "license": "0051466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Thomas Herbstritt House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Momence, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2011; 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.