NPIMap

Organization Active NPI

The House of the Good Shepherd

  • Public Health or Welfare Agency
  • Utica, NY
National Provider Identifier
1891989786
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
License
RID1658/VID00A01020 Issued in NY
Legal business name
THE HOUSE OF THE GOOD SHEPHERD
Practice address
1550 Champlin Ave
Utica, NY 13502-4828
Phone
(315) 235-7780
Fax
(315) 235-7789
NPI assigned
Sep 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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

Authorized official

Name
Mr. Brian McKee
Title
Ceo
Phone
(315) 235-7799

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X RID1658/VID00A01020 NY Primary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 8927040 NY

Addresses

Primary practice location

1550 Champlin Ave
Utica, NY 13502-4828

Mailing address

1550 Champlin Ave
Utica, NY 13502-4828
Phone (315) 235-7780

Other practice location 1

17 Herkimer Rd
Utica, NY 13502-2309
Phone (315) 235-7709

Other practice location 2

Partridge Berry Office Park
26515 NYS Route 3
Watertown, NY 13601
Phone (315) 782-8572

Other identifiers 2

IdentifierTypeStateIssuer
00356565MedicaidNY
01552327MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Psychiatric residential treatment facility certification: CCN 33L012

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
HOUSE OF THE GOOD SHEPHERD RTF
Certification status
Active
Provider type (POS)
Psychiatric residential treatment facility
Participating since
Nov 1, 2003
Last certification
Jun 9, 2022
Beds
14
Ownership / control type
Non-profit – other
Facility address
1550 Champlin Avenue
Utica, NY 13502

National Provider Directory

National Provider Directory

Locations

17 Herkimer Rd
Utica, NY 13502
Phone (315) 235-7700

1550 Champlin Ave
Utica, NY 13502
Phone (315) 235-7600

26515 Nys Route 3
Ofc Park
Watertown, NY 13601
Phone (315) 782-8572

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1188864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1891989786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 CHAMPLIN AVE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135024828",
            "telephone_number": "315-235-7780",
            "fax_number": "315-235-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 CHAMPLIN AVE",
            "city": "UTICA",
            "state": "NY",
            "postal_code": "135024828",
            "telephone_number": "315-235-7780",
            "fax_number": "315-235-7789"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17 Herkimer Rd",
            "address_purpose": "LOCATION",
            "city": "Utica",
            "state": "NY",
            "postal_code": "135022309",
            "country_code": "US",
            "telephone_number": "315-235-7709",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "Partridge Berry Office Park",
            "address_2": "26515 NYS Route 3",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "NY",
            "postal_code": "13601",
            "country_code": "US",
            "telephone_number": "315-782-8572",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "THE HOUSE OF THE GOOD SHEPHERD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-04",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-09",
        "status": "A",
        "authorized_official_last_name": "MCKEE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "315-235-7799",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "NY",
            "license": "RID1658/VID00A01020",
            "primary": true
        },
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "NY",
            "license": "8927040",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00356565",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01552327",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Utica, NY

Sources for this page

Verify at the official NPI Registry.