Good Shepherd Manor LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

GOOD SHEPHERD MANOR LLC

Practice address

302 Nordina St
Redlands, CA 92373-6022

Phone

(909) 798-2876

Fax

(909) 793-1188

NPI assigned

May 19, 2022

Organization subpart

No

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

Authorized official

Name

Irene Capili Macharelli

Title

Administrator

Phone

(909) 991-6939

Specialties & licenses 1

Addresses

Other names 1

• GOOD SHEPHERD MANOR LLC Doing business as

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

{
    "created_epoch": "1652918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1891432852",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 NORDINA ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923736022",
            "telephone_number": "909-798-2876",
            "fax_number": "909-793-1188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 NORDINA ST",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923736022",
            "telephone_number": "909-798-2876",
            "fax_number": "909-793-1188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-19",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A",
        "authorized_official_last_name": "MACHARELLI",
        "authorized_official_first_name": "IRENE",
        "authorized_official_middle_name": "CAPILI",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "909-991-6939"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GOOD SHEPHERD MANOR LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marisol Gonzalez, LMFT
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• Verenise Gonzalez
• Veronica L Gonzalez
• Corrinne I. Good, NP
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• Mark William Gorden, DDS
• Geanene Gordon, LCSW

• Mental Illness Community Based Residential Treatment Facility in Redlands, CA
• Providers in Redlands, CA by specialty
• Mental Illness Community Based Residential Treatment Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; 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.