Provider Demographics
NPI:1083323794
Name:GOOD SAM HEALING CENTER
Entity Type:Organization
Organization Name:GOOD SAM HEALING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GERRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALBROOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-215-7500
Mailing Address - Street 1:PO BOX 85002
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93380-5002
Mailing Address - Country:US
Mailing Address - Phone:661-215-7693
Mailing Address - Fax:661-215-7655
Practice Address - Street 1:8001 HERMOSA RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93307-9182
Practice Address - Country:US
Practice Address - Phone:661-215-7500
Practice Address - Fax:661-215-7655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care