Provider Demographics
NPI:1639202435
Name:GOOD SAMARITAN HOSPICE OF MADISON INC.
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOSPICE OF MADISON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-949-0400
Mailing Address - Street 1:135 GEMINI CIR STE 202
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5842
Mailing Address - Country:US
Mailing Address - Phone:205-949-0400
Mailing Address - Fax:205-949-0405
Practice Address - Street 1:540 HUGHES RD
Practice Address - Street 2:SUITE 12
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-8999
Practice Address - Country:US
Practice Address - Phone:256-767-4799
Practice Address - Fax:256-767-4798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL78274251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL011676Medicare Oscar/Certification