Provider Demographics
NPI:1922092451
Name:GOOD SAMARITAN HOME CARE SERVICES OF VINCENNES, IN, LLC
Entity Type:Organization
Organization Name:GOOD SAMARITAN HOME CARE SERVICES OF VINCENNES, IN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE, CFO
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-576-8478
Mailing Address - Street 1:6281 TRI RIDGE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-8345
Mailing Address - Country:US
Mailing Address - Phone:513-576-0262
Mailing Address - Fax:
Practice Address - Street 1:328 N 2ND ST STE 300
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1353
Practice Address - Country:US
Practice Address - Phone:812-885-2767
Practice Address - Fax:812-885-2769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200500550AMedicaid
IN200502090AMedicaid
IN200502090AMedicaid