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GOOD SHEPHERD HOSPICE

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Company Details

Name: GOOD SHEPHERD HOSPICE
Jurisdiction: New York
Legal type: DOMESTIC NOT-FOR-PROFIT CORPORATION
Status: Active
Date of registration: 30 Jan 1989 (36 years ago)
Entity Number: 1321544
ZIP code: 11777
County: Suffolk
Place of Formation: New York
Address: 4747-20 NESCONSET HIGHWAY, PORT JEFFERSON STAT., NY, United States, 11777

Contact Details

Phone +1 631-828-7400

Phone +1 631-828-7417

Fax +1 631-465-6300

Phone +1 631-361-8800

Phone +1 631-244-2400

Phone +1 631-465-6300

Phone +1 631-587-1600

Phone +1 516-374-9300

Phone +1 516-365-9229

Phone +1 516-621-5400

Phone +1 631-422-4800

Phone +1 516-889-1100

Phone +1 631-715-2000

Phone +1 631-264-4000

Phone +1 561-775-2100

Phone +1 516-523-8000

Phone +1 631-423-3673

Phone +1 516-536-2300

Phone +1 631-924-8830

Phone +1 631-724-2200

DOS Process Agent

Name Role Address
THE CORPORATION DOS Process Agent 4747-20 NESCONSET HIGHWAY, PORT JEFFERSON STAT., NY, United States, 11777

National Provider Identifier

NPI Number:
1992131635
Certification Date:
2023-09-28

Authorized Person:

Name:
DR. KERRIANNE P PAGE
Role:
CHIEF MEDICAL OFFICER
Phone:

Taxonomy:

Selected Taxonomy:
207LH0002X - Hospice and Palliative Medicine (Anesthesiology) Physician
Is Primary:
Yes

Contacts:

Fax:
6318287494

History

Start date End date Type Value
2006-04-12 2007-06-20 Address 4747-20 NESCONSET HIGHWAY, PORT JEFFERSON STA., NY, 11776, USA (Type of address: Service of Process)
1989-01-30 2006-04-12 Address 200 BELLE TERRE ROAD, PORT JEFFERSON, NY, 11777, USA (Type of address: Service of Process)

Filings

Filing Number Date Filed Type Effective Date
070620000423 2007-06-20 CERTIFICATE OF AMENDMENT 2007-06-20
060412000791 2006-04-12 CERTIFICATE OF CHANGE 2006-04-12
020830000384 2002-08-30 CERTIFICATE OF MERGER 2002-09-01
B735263-10 1989-01-30 CERTIFICATE OF INCORPORATION 1989-01-30

Tax Exempt

Employer Identification Number (EIN) :
11-2958438
In Care Of Name:
% CHS SERVICES INC
Classification:
Government Instrumentality, Title-Holding Corporation, Charitable Organization, Agricultural Organization, Board of Trade, Pleasure, Recreational, or Social Club, Fraternal Beneficiary Society, Order or Association, Voluntary Employees' Beneficiary Association (Non-Govt. Emps.), Domestic Fraternal Societies and Associations, Teachers Retirement Fund Assoc., Benevolent Life Insurance Assoc., Burial Association, Credit Union, Mutual Insurance Company or Assoc. Other Than Life or Marine, Corp. Financing Crop Operations, Supplemental Unemployment Compensation Trust or Plan, Employee Funded Pension Trust (Created Before 6/25/59), Post or Organization of War Veterans, Legal Service Organization, Black Lung Trust, Multiemployer Pension Plan, Veterans Assoc. Formed Prior to 1880, Trust Described in Sect. 4049 of ERISA, Title Holding Co. for Pensions, etc., State-Sponsored High Risk Health Insurance Organizations, State-Sponsored Workers' Compensation Reinsurance, ACA 1322 Qualified Nonprofit Health Insurance Issuers, Apostolic and Religious Org. (501(d)), Cooperative Hospital Service Organization (501(e)), Cooperative Service Organization of Operating Educational Organization (501(f)), Child Care Organization (501(k)), Charitable Risk Pool, Qualified State-Sponsored Tuition Program, 4947(a)(1) - Private Foundation (Form 990PF Filer)
Ruling Date:
1946-03

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Date of last update: 16 Mar 2025

Sources: New York Secretary of State