Provider Demographics
NPI:1770117616
Name:GOOD SHEPHERD PCA SERVICES
Entity type:Organization
Organization Name:GOOD SHEPHERD PCA SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PCA MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ARCEO
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:702-966-7118
Mailing Address - Street 1:2235 E FLAMINGO RD.
Mailing Address - Street 2:SUITE #170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5186
Mailing Address - Country:US
Mailing Address - Phone:702-966-7118
Mailing Address - Fax:702-839-0095
Practice Address - Street 1:2235 E FLAMINGO RD.
Practice Address - Street 2:SUITE #170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5186
Practice Address - Country:US
Practice Address - Phone:702-966-7118
Practice Address - Fax:702-839-0095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-01
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250007037Medicaid
NV9722-PCA-0OtherPERSONAL CARE AGENCY