Provider Demographics
NPI:1740618305
Name:GOOD SAMARITAN FOSTER CARE LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN FOSTER CARE LLC
Other - Org Name:GOOD SAMARITAN FOSTER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW, LCSW
Authorized Official - Phone:405-212-7466
Mailing Address - Street 1:545 W STROTHERS AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:OK
Mailing Address - Zip Code:74868-3126
Mailing Address - Country:US
Mailing Address - Phone:405-382-2434
Mailing Address - Fax:405-382-2406
Practice Address - Street 1:545 W STROTHERS AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:OK
Practice Address - Zip Code:74868-3126
Practice Address - Country:US
Practice Address - Phone:405-382-2434
Practice Address - Fax:405-382-2406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-17
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKK860051482253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200517220 AMedicaid