GOOD SHEPHERD MANOR INC (NPI# 1750659199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750659199 |
| Entity Type | Organization |
| Organization Name | GOOD SHEPHERD MANOR INC |
| Other Organization Name | THOMAS HERBSTRITT HOUSE |
| Practice Address |
4003 N. Routes 1 & 17 Momence IL 60954-0260 |
| Mailing Address |
Po Box 260 Momence IL 60954-0260 |
| Practice Telephone | 8154723700 |
| Practice Fax Number | 8154726086 |
| Mailing Telephone | 8154723700 |
| Mailing Fax Number | 8154726086 |
| Enumeration Date | 2011-12-13 |
| Last Update Date | 2011-12-13 |
| Authorized Official Name | MR. BRUCE ROBERT FITZPATRICK (PRESIDENT) |
| Authorized Official Telephone | 8154723700 |
| Is Organization Subpart | Y |
| Parent Organization Name | GOOD SHEPHERD MANOR INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 0051466 | IL | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Thomas Herbstritt House | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841568284 | Good Shepherd Manor Inc | Intermediate Care Facility, Mentally Retarded | 4129a N. State Routes 1 & 17, Momence, IL 60954-0260 | 2011-12-13 |
| Street Address |
4003 N. ROUTES 1 & 17 |
| City | MOMENCE |
| State | IL |
| Zip Code | 60954-0260 |
| 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 |
| 1689998700 | Good Shepherd Manor Groups Homes, Inc | Intermediate Care Facility, Mentally Retarded | 4129 N State Routes 1 & 17, Momence, IL 60954 | 2010-03-18 |
| 1841568284 | Good Shepherd Manor Inc | Intermediate Care Facility, Mentally Retarded | 4129a N. State Routes 1 & 17, Momence, IL 60954-0260 | 2011-12-13 |
| 1700100971 | Good Shepherd Manor, Inc | Custodial Care Facility | 4129 N State Routes 1 & 17, Momence, IL 60954-0260 | 2010-03-17 |
| Find all providers in zip 60954 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841568284 | Good Shepherd Manor Inc | Intermediate Care Facility, Mentally Retarded | 4129a N. State Routes 1 & 17, Momence, IL 60954-0260 | 2011-12-13 |
| 1689998700 | Good Shepherd Manor Groups Homes, Inc | Intermediate Care Facility, Mentally Retarded | 4129 N State Routes 1 & 17, Momence, IL 60954 | 2010-03-18 |
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|---|---|---|---|---|
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| 1770930968 | Community Support Systems | Intermediate Care Facility, Mentally Retarded | 2311 Veterans Drive, Effingham, IL 62401 | 2016-05-18 |
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| 1164888160 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 1406 W Delaware St, Fairfield, IL 62837-2336 | 2016-01-06 |
| 1376909374 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 416 Chula Vista Dr, Belleville, IL 62221-3160 | 2016-01-06 |
| 1437515434 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 206 N Washington St, Mc Leansboro, IL 62859-1049 | 2016-01-06 |
| 1790141885 | Tdl Group, Inc | Intermediate Care Facility, Mentally Retarded | 212 Turning Leaf Cir, Belleville, IL 62221-6747 | 2016-01-06 |
| 1790141794 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 867 County Road 2150 E, Fairfield, IL 62837-2824 | 2016-01-06 |
| 1255797254 | Tdl Group, Inc. | Intermediate Care Facility, Mentally Retarded | 9135 N Spring Garden Ln, Mount Vernon, IL 62864-6624 | 2016-01-06 |
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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.