Provider Demographics
NPI:1598936452
Name:SAMARITAN FAMILY CARE INC
Entity Type:Organization
Organization Name:SAMARITAN FAMILY CARE INC
Other - Org Name:PREMIER EXPRESS CARE OF ENGLEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-8213
Mailing Address - Street 1:885 UNION ROAD
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45322
Mailing Address - Country:US
Mailing Address - Phone:937-836-3427
Mailing Address - Fax:937-836-3808
Practice Address - Street 1:885 UNION ROAD
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45322
Practice Address - Country:US
Practice Address - Phone:937-836-3427
Practice Address - Fax:937-836-3808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAMARITAN FAMILY CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGroup - Single Specialty