Provider Demographics
NPI:1043608169
Name:GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Other - Org Name:GOOD SAMARITAN SOCIETY- HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEN HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-5510
Mailing Address - Street 1:7304 GOOD SAMARITAN CT STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1602
Mailing Address - Country:US
Mailing Address - Phone:915-533-0999
Mailing Address - Fax:915-533-0997
Practice Address - Street 1:7304 GOOD SAMARITAN CT STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1602
Practice Address - Country:US
Practice Address - Phone:915-533-0999
Practice Address - Fax:915-533-0997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001019645Medicaid
TX67-1666Medicare UPIN