Provider Demographics
NPI:1063839843
Name:GOOD SAMARITAN
Entity Type:Organization
Organization Name:GOOD SAMARITAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TREATMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-346-8185
Mailing Address - Street 1:104 S C ST
Mailing Address - Street 2:A
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6924
Mailing Address - Country:US
Mailing Address - Phone:805-736-0357
Mailing Address - Fax:800-969-9350
Practice Address - Street 1:104 S C ST
Practice Address - Street 2:A
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6924
Practice Address - Country:US
Practice Address - Phone:805-736-0357
Practice Address - Fax:800-969-9350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No251S00000XAgenciesCommunity/Behavioral Health