Provider Demographics
NPI:1932499977
Name:GOOD SAMARITAN CARE CENTER ALF INC
Entity Type:Organization
Organization Name:GOOD SAMARITAN CARE CENTER ALF INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOROTA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOSZYK-WIELGUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-437-6244
Mailing Address - Street 1:6 RESTON PL
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-6605
Mailing Address - Country:US
Mailing Address - Phone:386-437-6244
Mailing Address - Fax:386-437-6244
Practice Address - Street 1:6 RESTON PL
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-6605
Practice Address - Country:US
Practice Address - Phone:386-437-6244
Practice Address - Fax:386-437-6244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-11
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10381310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility