Provider Demographics
NPI:1265034292
Name:GOOD SAMARITAN HEALTHCARE LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FELIMON
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-612-2251
Mailing Address - Street 1:10000 N 31ST AVE STE D307B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85051-9582
Mailing Address - Country:US
Mailing Address - Phone:602-612-2251
Mailing Address - Fax:
Practice Address - Street 1:10000 N 31ST AVE STE D307B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-9582
Practice Address - Country:US
Practice Address - Phone:602-612-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health