Provider Demographics
NPI:1003817248
Name:GOOD SAMARITAN NURSING HOME
Entity Type:Organization
Organization Name:GOOD SAMARITAN NURSING HOME
Other - Org Name:GOOD SAMARITAN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:NELL
Authorized Official - Last Name:STELLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-668-4515
Mailing Address - Street 1:403 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLE CAMP
Mailing Address - State:MO
Mailing Address - Zip Code:65325-1144
Mailing Address - Country:US
Mailing Address - Phone:660-668-4515
Mailing Address - Fax:660-668-4975
Practice Address - Street 1:403 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COLE CAMP
Practice Address - State:MO
Practice Address - Zip Code:65325-1144
Practice Address - Country:US
Practice Address - Phone:660-668-4515
Practice Address - Fax:660-668-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029352314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101487304Medicaid
MO265770Medicare Oscar/Certification