Provider Demographics
NPI:1841570124
Name:GSH, LLC
Entity Type:Organization
Organization Name:GSH, LLC
Other - Org Name:GOOD SAMARITAN HOMES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS DEVELOPMENT MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TWYMAN
Authorized Official - Middle Name:DWAYNE
Authorized Official - Last Name:MILLERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-235-0780
Mailing Address - Street 1:3690 DAYTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45414-4406
Mailing Address - Country:US
Mailing Address - Phone:937-235-0780
Mailing Address - Fax:937-235-0788
Practice Address - Street 1:3690 DAYTON PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45414-4406
Practice Address - Country:US
Practice Address - Phone:937-235-0780
Practice Address - Fax:937-235-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5702896253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2484986Medicaid