Provider Demographics
NPI:1760004089
Name:GOOD SHEPERDS CARE SERVICES INC
Entity type:Organization
Organization Name:GOOD SHEPERDS CARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:
Authorized Official - Last Name:OKENDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-451-5531
Mailing Address - Street 1:4802 E W T HARRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215-1903
Mailing Address - Country:US
Mailing Address - Phone:704-451-5531
Mailing Address - Fax:
Practice Address - Street 1:4802 E W T HARRIS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-1903
Practice Address - Country:US
Practice Address - Phone:704-451-5531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-08
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care