Provider Demographics
NPI:1417949892
Name:GOOD SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPITAL
Other - Org Name:GOOD SAMARITAN HOME HEALTH & HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS,RN,CHCE,CDHP
Authorized Official - Phone:253-697-7600
Mailing Address - Street 1:PO BOX 1247
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-0192
Mailing Address - Country:US
Mailing Address - Phone:253-697-7600
Mailing Address - Fax:253-697-5191
Practice Address - Street 1:1317 E MAIN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3136
Practice Address - Country:US
Practice Address - Phone:253-697-7600
Practice Address - Fax:253-691-9598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAIS302251F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251F00000XAgenciesHome Infusion
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0004OtherCHAMPUS HOME HEALTH
WA7330079Medicaid
WA1258OtherPREMERA
WAWA2923OtherMOLINA
WA0543130001OtherCIGNA MEDICARE
WAGO4586OtherREGENCE HIT
WA507033Medicare ID - Type UnspecifiedMEDICARE