NPIMap

Organization Active NPI

Friends of Good Shepherd Manor

  • Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
  • Lucasville, OH
National Provider Identifier
1912110925
Registry record updated Feb 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X
License
6600173 Issued in OH
Legal business name
FRIENDS OF GOOD SHEPHERD MANOR
Practice address
374 Good Manor Rd.
Lucasville, OH 45648-1029
Phone
(740) 289-2861
Fax
(740) 289-3916
NPI assigned
May 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2009

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

Authorized official

Name
Ms. Jackie Brenda Bowling
Title
Executive Director
Phone
(740) 289-2861

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 6610055 OH
Intellectual Disabilities Intermediate Care Facility 315P00000X 6610153 OH
Intellectual Disabilities Intermediate Care Facility 315P00000X 6610306 OH
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility 320900000X 6600173 OH Primary

Addresses

Primary practice location

374 Good Manor Rd.
Lucasville, OH 45648-1029

Mailing address

PO Box 1029
Lucasville, OH 45648-1029
Phone (740) 289-2861

Other identifiers 1

IdentifierTypeStateIssuer
0830364MedicaidOH

National Provider Directory

National Provider Directory
Tax ID family
Friends of Good Shepherd Manor3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1234310400000",
    "number": "1912110925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1029",
            "city": "LUCASVILLE",
            "state": "OH",
            "postal_code": "456481029",
            "telephone_number": "740-289-2861",
            "fax_number": "740-289-3916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 GOOD MANOR RD.",
            "city": "LUCASVILLE",
            "state": "OH",
            "postal_code": "456481029",
            "telephone_number": "740-289-2861",
            "fax_number": "740-289-3916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRIENDS OF GOOD SHEPHERD MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-07",
        "last_updated": "2009-02-11",
        "status": "A",
        "authorized_official_last_name": "BOWLING",
        "authorized_official_first_name": "JACKIE",
        "authorized_official_middle_name": "BRENDA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "740-289-2861",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "6610055",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "6610153",
            "primary": false
        },
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "OH",
            "license": "6610306",
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "OH",
            "license": "6600173",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0830364",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lucasville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2009; 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.