Provider Demographics
NPI:1417322728
Name:GOOD SAMARITAN SOCIETY
Entity Type:Organization
Organization Name:GOOD SAMARITAN SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:712-330-2732
Mailing Address - Street 1:721 S KIEL ST
Mailing Address - Street 2:
Mailing Address - City:HOLSTEIN
Mailing Address - State:IA
Mailing Address - Zip Code:51025-5041
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:721 S KIEL ST
Practice Address - Street 2:
Practice Address - City:HOLSTEIN
Practice Address - State:IA
Practice Address - Zip Code:51025-5041
Practice Address - Country:US
Practice Address - Phone:712-330-2732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000999320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities