Organization · Type 2 NPI
Good Shepherd Manor Inc
Intellectual Disabilities Intermediate Care Facility · Momence, IL
NPI number
1750659199
Active
Practice location
4003 N. Routes 1 & 17
Momence, IL 60954-0260
Fax (815) 472-6086
Mailing address
PO Box 260
Momence, IL 60954-0260
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual Disabilities Intermediate Care Facility Primary | 315P00000X | 0051466 (IL) |
Intellectual Disabilities Intermediate Care Facility: An intermediate care facility providing services for individuals with intellectual disabilities.
Other intellectual disabilities intermediate care facility providers in Momence
About NPI 1750659199
Good Shepherd Manor Inc's National Provider Identifier is 1750659199, issued on Dec 13, 2011. The primary taxonomy on file is Intellectual Disabilities Intermediate Care Facility (315P00000X), and the practice location is in Momence, IL. The record was last updated on Dec 13, 2011.