Provider Demographics
NPI:1891874798
Name:THE GOOD SAMARITAN HOSPITAL
Entity Type:Organization
Organization Name:THE GOOD SAMARITAN HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE & CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-270-7806
Mailing Address - Street 1:FOURTH AND WILLOW STREETS
Mailing Address - Street 2:PO BOX 1281
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-1281
Mailing Address - Country:US
Mailing Address - Phone:717-274-7580
Mailing Address - Fax:717-228-0249
Practice Address - Street 1:FOURTH AND WILLOW STREETS
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-274-7580
Practice Address - Fax:717-228-0249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE GOOD SAMARITAN HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-03
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA121102314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA395933OtherKEYSTONE HEALTH PLAN CENT
395933OtherADVANTRA
PA08274OtherHEALTH PARTNERS
395933OtherSTERLING OPTION 1
PA60685OtherAMERIHEALTH MERCY
PA7510OtherAETNA
PA395933OtherCAPITAL BLUE CROSS
395933OtherHUMANA GOLD
395933OtherGEISINGER GOLD
PA1018197OtherKEYSTONE MERCY
PA1558OtherHIGHMARK BLUE SHIELD
PA1018197OtherGATEWAY MEDICARE ASSURED
1558OtherHIGHMARK FREEDOM BLUE
PA33781OtherHEALTH AMERICA
395933Medicare Oscar/Certification