Provider Demographics
NPI:1497833313
Name:GOOD SAMARITAN HOSPICE LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:PICARDO
Authorized Official - Last Name:VALLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:951-415-3311
Mailing Address - Street 1:330 S MAPLE ST UNIT J2
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92880-6947
Mailing Address - Country:US
Mailing Address - Phone:951-271-7900
Mailing Address - Fax:
Practice Address - Street 1:330 S MAPLE ST
Practice Address - Street 2:UNIT J
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92880-6947
Practice Address - Country:US
Practice Address - Phone:951-271-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based