Provider Demographics
NPI: | 1629296645 |
---|---|
Name: | SAMARITAN HOUSE INC. |
Entity Type: | Organization |
Organization Name: | SAMARITAN HOUSE INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | STEVEN |
Authorized Official - Last Name: | GOLDFADEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSW |
Authorized Official - Phone: | 410-269-5605 |
Mailing Address - Street 1: | P.O BOX 6039 |
Mailing Address - Street 2: | |
Mailing Address - City: | ANNAPOLIS |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21401 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 410-269-5605 |
Mailing Address - Fax: | 410-268-6965 |
Practice Address - Street 1: | 2610 GREENBRIAR LN. |
Practice Address - Street 2: | |
Practice Address - City: | ANNAPOLIS |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21401 |
Practice Address - Country: | US |
Practice Address - Phone: | 410-269-5605 |
Practice Address - Fax: | 410-268-6965 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-04-23 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 903029 | 324500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 324500000X | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |