GOOD SHEPHERD MANOR GROUPS HOMES, INC
NPI 1689998700
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities in Momence, IL

Q: What is Good Shepherd Manor Groups Homes, Inc's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Active since March 18, 2010CLIA 14D1055712 · Waiver

4129 N STATE ROUTES 1 & 17, MOMENCE, IL 60954(815) 472-3700(815) 472-6086 Get Directions Write a Review

NPPES record last updated: March 18, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Good Shepherd Manor Groups Homes, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GOOD SHEPHERD MANOR GROUPS HOMES, INC (NPI 1689998700) is a healthcare organization registered as a community based residential treatment facility, intellectual and/or developmental disabilities in Momence, Illinois and active in the NPI registry since March 2010. The organization holds a CLIA Waiver certificate valid through June 22, 2028 and lists Bruce Robert Fitzpatrick, President, as its authorized official.

NPPES Registry Identity

NPI1689998700

Entity TypeOrganization

Primary Taxonomy320900000X

Legal Business NameGOOD SHEPHERD MANOR GROUPS HOMES, INC

Location Address4129 N STATE ROUTES 1 & 17Momence, IL 60954

Mailing AddressPo Box 260, 4129 N State Routes 1 & 17Momence, IL 60954-0260 · (815) 472-3700 · Fax (815) 472-6086

Phone(815) 472-3700

Fax(815) 472-6086

Organization SubpartNo

Authorized OfficialBruce Robert FitzpatrickPresident · (815) 472-3700

Enumeration DateMarch 18, 2010

✔ NPI 1689998700 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesResidential Treatment Facilities

Taxonomy Code320900000X

License✔ Licensed in IL · 96S015

Definition

A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities.

Also ListedIntermediate Care Facility, Intellectual DisabilitiesTaxonomy 315P00000X · License 0041913 (IL), 41905 (IL)

4129 N STATE ROUTES 1 & 17, Momence, IL 60954

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 14D1055712

Good Shepherd Manor Inc · Momence, IL

Active · expires Jun 22, 2028

CLIA Number14D1055712

Laboratory TypeIntermediate Care Facility For Mentally Retarded

Certificate Effective DateJune 23, 2026

Certificate Expiration DateJune 22, 2028

Laboratory DirectorBruce R. Fitzpatrick

Laboratory Phone(815) 472-3700

Laboratory LocationGood Shepherd Manor Inc4129 N State Route 1-17, Momence, IL 60954

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GOOD SHEPHERD MANOR, INC

Day Training, Developmentally Disabled Services

4129 N STATE ROUTES 1 & 17
MOMENCE, IL 60954

Kankakee County (815) 472-3700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Good Shepherd Manor Groups Homes, Inc's NPI number?

The NPI number for Good Shepherd Manor Groups Homes, Inc is 1689998700. It was assigned to this organization in the NPPES registry on March 18, 2010.

Where is Good Shepherd Manor Groups Homes, Inc located?

Good Shepherd Manor Groups Homes, Inc is located at 4129 N State Routes 1 & 17, Momence, IL 60954. The listed phone number is (815) 472-3700.

What is Good Shepherd Manor Groups Homes, Inc's specialty?

The primary specialty registered for this NPI is Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities with taxonomy code 320900000X.

Does Good Shepherd Manor Groups Homes, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 14D1055712) is associated with this NPI, valid through June 22, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Good Shepherd Manor Groups Homes, Inc was last updated on March 18, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.