Provider Demographics
NPI:1790451755
Name:GOOD SAMARITAN HOME HEALTH LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOME HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEVENTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:702-525-5653
Mailing Address - Street 1:4550 W OAKEY BLVD STE 111-H
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1581
Mailing Address - Country:US
Mailing Address - Phone:725-204-0355
Mailing Address - Fax:702-852-0662
Practice Address - Street 1:4550 W OAKEY BLVD STE 111-H
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1581
Practice Address - Country:US
Practice Address - Phone:725-204-0355
Practice Address - Fax:702-852-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health