GOOD SHEPHERD MANOR, INC (NPI# 1700100971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700100971 |
| Entity Type | Organization |
| Organization Name | GOOD SHEPHERD MANOR, INC |
| Practice Address |
4129 N State Routes 1 & 17 Momence IL 60954-0260 |
| 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 | 2010-03-17 |
| Last Update Date | 2010-03-17 |
| 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 | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
0002865 | IL | Nursing & Custodial Care Facilities |
| Y | 251C00000X | Day Training, Developmentally Disabled Services | 6-374 | IL | Agencies |
| Street Address |
4129 N STATE ROUTES 1 & 17 |
| City | MOMENCE |
| State | IL |
| Zip Code | 60954-0260 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689998700 | Good Shepherd Manor Groups Homes, Inc | Intermediate Care Facility, Mentally Retarded | 4129 N State Routes 1 & 17, Momence, IL 60954 | 2010-03-18 |
| 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 | 251C00000X |
| Grouping | Agencies |
| Classification | Day Training, Developmentally Disabled Services |
| These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619515665 | People Overcoming With Everlasting Results, Inc. | Day Training, Developmentally Disabled Services | 6400 W Main St Ste 1f-3, Belleville, IL 62223-3806 | 2019-12-19 |
| 1386132520 | It Takes A Community LLC | Day Training, Developmentally Disabled Services | 9046 S Justine St, Chicago, IL 60620 | 2018-04-24 |
| 1215424460 | Victor C. Neumann Association | Day Training, Developmentally Disabled Services | 4434 W Diversey Ave, Chicago, IL 60639-1939 | 2018-04-13 |
| 1194212399 | Victor C Neumann Association | Day Training, Developmentally Disabled Services | 4122 N Nashville Ave, Chicago, IL 60634-1429 | 2018-04-13 |
| 1952825770 | Help At Home, LLC | Day Training, Developmentally Disabled Services | 1 N State St Ste 800, Chicago, IL 60602-3312 | 2017-08-02 |
| 1316478878 | Kathryn Elaine Miller Rose | Day Training, Developmentally Disabled Services | 1207 Lakeside Ln, Mahomet, IL 61853-9767 | 2017-03-25 |
| 1063943645 | Lf Walls Corp | Day Training, Developmentally Disabled Services | 1404 Fox Hound Trl, Beecher, IL 60401-5106 | 2017-03-24 |
| 1285186254 | Dorr-wood Ltd | Day Training, Developmentally Disabled Services | 1001 Rail Dr, Woodstock, IL 60098-9411 | 2016-10-26 |
| 1558818930 | Autismchicago | Day Training, Developmentally Disabled Services | 8035 S Wabash Ave, Chicago, IL 60619-3516 | 2016-09-02 |
| 1518411594 | Transitions of Western Illinois | Day Training, Developmentally Disabled Services | 631 N 48th St, Quincy, IL 62305-7918 | 2016-08-08 |
| 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.