GOOD SHEPHERD MANOR GROUPS HOMES, INC (NPI# 1689998700) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689998700 |
| Entity Type | Organization |
| Organization Name | GOOD SHEPHERD MANOR GROUPS HOMES, INC |
| Practice Address |
4129 N State Routes 1 & 17 Momence IL 60954 |
| Mailing Address |
Po Box 260 4129 N State Routes 1 & 17 Momence IL 60954-0260 |
| Practice Telephone | 8154723700 |
| Practice Fax Number | 8154726086 |
| Mailing Telephone | 8154723700 |
| Mailing Fax Number | 8154726086 |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2010-03-18 |
| Authorized Official Name | MR. BRUCE ROBERT FITZPATRICK (PRESIDENT) |
| Authorized Official Telephone | 8154723700 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | 0041913 | IL | Nursing & Custodial Care Facilities |
| N | 315P00000X | Intermediate Care Facility, Mentally Retarded | 41905 | IL | Nursing & Custodial Care Facilities |
| Y | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 96S015 | IL | Residential Treatment Facilities |
| Street Address |
4129 N STATE ROUTES 1 & 17 |
| City | MOMENCE |
| State | IL |
| Zip Code | 60954 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700100971 | Good Shepherd Manor, Inc | Custodial Care Facility | 4129 N State Routes 1 & 17, Momence, IL 60954-0260 | 2010-03-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194373001 | Zoe Luedtke | Technician | 11841 E. Gregg Blvd., Momence, IL 60954 | 2019-09-04 |
| 1285096768 | Stacy Blider | Occupational Therapy Assistant | 932 Louise Dr, Momence, IL 60954 | 2016-03-24 |
| 1427302413 | Garden of Prayer Youth Center | Community/Behavioral Health | 16424 East State Route 114, Momence, IL 60954 | 2012-10-30 |
| 1235376161 | Doc's Drugs Ltc | Skilled Nursing Facility | 2764 North Route 1-17, B, Momence, IL 60954 | 2009-01-14 |
| 1477741452 | Exceptional Health Partners S.c. | Family Medicine | 13043 S.e. 2260 Rd, Momence, IL 60954 | 2007-10-04 |
| 1790800597 | Momence Community Unit School District #1 | Local Education Agency (LEA) | 415 N Dixie Highway, Momence, IL 60954 | 2007-03-20 |
| 1063598068 | Highland Park Cvs, L.L.C. | Durable Medical Equipment & Medical Supplies | 2764 N. Route 1-17, Momence, IL 60954 | 2006-10-31 |
| 1750659199 | Good Shepherd Manor Inc | Intermediate Care Facility, Mentally Retarded | 4003 N. Routes 1 & 17, Momence, IL 60954-0260 | 2011-12-13 |
| 1841568284 | Good Shepherd Manor Inc | Intermediate Care Facility, Mentally Retarded | 4129a N. State Routes 1 & 17, Momence, IL 60954-0260 | 2011-12-13 |
| 1740708551 | Lindsay Bannerman | Psychologist | 400 N Pine St, Momence, IL 60954-1158 | 2017-08-31 |
| Find all providers in zip 60954 | ||||
| Taxonomy Code | 320900000X |
| Grouping | Residential Treatment Facilities |
| Classification | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities |
| A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275131419 | Foatex Health Cilacare | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 823 163rd St, Calumet City, IL 60409-5915 | 2020-10-10 |
| 1053949404 | A Great Place To Stay LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 35580 N Knowles Rd, Lake Villa, IL 60046-9026 | 2020-03-31 |
| 1255966602 | Infinicare LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1939 Waukegan Rd Ste 300, Glenview, IL 60025-1758 | 2020-03-05 |
| 1023643772 | Supporting Community Independence | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1 Polo Grounds Ct, Bethalto, IL 62010-2623 | 2020-03-03 |
| 1770116287 | Universal Homes LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 12101 S La Salle St, Chicago, IL 60628-6618 | 2020-02-13 |
| 1760014625 | Tomeka R Morgan | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 11543 S Ashland Ave, Chicago, IL 60643-5001 | 2020-02-10 |
| 1487292660 | Shalom Home Health Ltd | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8147 Seminole Ct, Orland Park, IL 60462-4919 | 2019-12-18 |
| 1447894613 | Compassionate Living Home Inc | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 2625 Butterfield Rd Ste 314e, Oak Brook, IL 60523-1234 | 2019-10-31 |
| 1417599945 | Miracle Comprehensive Serivces | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4440 Lincoln Hwy Ste 205, Matteson, IL 60443-3803 | 2019-10-16 |
| 1609435072 | Bliss Haven, Inc. | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 1304 Durham St, Johnston City, IL 62951-2043 | 2019-06-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.