Provider Demographics
NPI:1821267527
Name:GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Other - Org Name:GOOD SAMARITAN SOCIETY-HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-3900
Mailing Address - Street 1:3901 MONTECITO DR STE A
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-5557
Mailing Address - Country:US
Mailing Address - Phone:940-565-6338
Mailing Address - Fax:940-565-6339
Practice Address - Street 1:3901 MONTECITO DR STE A
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-5557
Practice Address - Country:US
Practice Address - Phone:940-565-6338
Practice Address - Fax:940-565-6339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-27
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX677843Medicare Oscar/Certification