Provider Demographics
NPI:1952488348
Name:GOOD SAMARITAN CENTER
Entity Type:Organization
Organization Name:GOOD SAMARITAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SKURDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-422-3814
Mailing Address - Street 1:201 HALL ST
Mailing Address - Street 2:
Mailing Address - City:WEST UNION
Mailing Address - State:IA
Mailing Address - Zip Code:52175-1006
Mailing Address - Country:US
Mailing Address - Phone:563-422-3814
Mailing Address - Fax:563-422-3815
Practice Address - Street 1:201 HALL ST
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:IA
Practice Address - Zip Code:52175-1006
Practice Address - Country:US
Practice Address - Phone:563-422-3814
Practice Address - Fax:563-422-3815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAN406314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0801597Medicaid
165187Medicare ID - Type Unspecified