Provider Demographics
NPI:1043450950
Name:GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Other - Org Name:GOOD SAMARITAN SOCIETY-HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-3900
Mailing Address - Street 1:700 N TOWN EAST BLVD APT 159
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-4793
Mailing Address - Country:US
Mailing Address - Phone:972-686-4366
Mailing Address - Fax:972-686-4372
Practice Address - Street 1:607 W MAGNOLIA AVE STE 205
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4608
Practice Address - Country:US
Practice Address - Phone:972-686-4366
Practice Address - Fax:972-686-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX679113Medicare UPIN