Provider Demographics
NPI:1508530973
Name:GOOD SAMARITAN HOME CARE
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOME CARE
Other - Org Name:AZA SIMS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AZA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-964-4335
Mailing Address - Street 1:30 S 15TH ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4826
Mailing Address - Country:US
Mailing Address - Phone:215-964-4335
Mailing Address - Fax:267-799-2492
Practice Address - Street 1:30 S 15TH ST FL 15
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4806
Practice Address - Country:US
Practice Address - Phone:215-258-4285
Practice Address - Fax:267-799-2492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-09
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA57773601OtherHOME CARE AGENCY/HOME CARE REGISTRY