Provider Demographics
NPI:1730225590
Name:GOOD SHEPHERD SCHOOL FOR CHILDREN
Entity type:Organization
Organization Name:GOOD SHEPHERD SCHOOL FOR CHILDREN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:314-469-0606
Mailing Address - Street 1:1170 TIMBER RUN DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4482
Mailing Address - Country:US
Mailing Address - Phone:314-469-0606
Mailing Address - Fax:314-469-3294
Practice Address - Street 1:1170 TIMBER RUN DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63146-4482
Practice Address - Country:US
Practice Address - Phone:314-469-0606
Practice Address - Fax:314-469-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO39420OtherGROUP HEALTH PLAN
MO39420OtherCARE MANAGEMENT RESOURCES
MO131233OtherBLUE CROSS BLUE SHIELD
MO39420OtherCARPENTERS HEALTH AND WEL
MO507419703Medicaid
MO39420OtherGROUP HEALTH PLAN