Provider Demographics
NPI:1528218989
Name:GOOD SAMARITAN SHELTER, INC.
Entity Type:Organization
Organization Name:GOOD SAMARITAN SHELTER, INC.
Other - Org Name:ANOTHER ROAD DETOX
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-346-8185
Mailing Address - Street 1:731 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-6107
Mailing Address - Country:US
Mailing Address - Phone:805-346-8185
Mailing Address - Fax:805-346-8656
Practice Address - Street 1:113 SOUTH M STREET
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6630
Practice Address - Country:US
Practice Address - Phone:805-736-0357
Practice Address - Fax:805-346-8656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility