Provider Demographics
NPI:1699212787
Name:GOOD SAMARITAN HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SOFIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARUTUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-783-8124
Mailing Address - Street 1:1775 WEHRLE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7093
Mailing Address - Country:US
Mailing Address - Phone:716-783-8124
Mailing Address - Fax:716-783-8122
Practice Address - Street 1:1775 WEHRLE DR STE 200
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14221-7093
Practice Address - Country:US
Practice Address - Phone:716-783-8124
Practice Address - Fax:716-783-8122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1986L001251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1986L001OtherNEW YORK DEPARTMENT OF HEALTH LICENSE