Provider Demographics
NPI:1184886319
Name:GOOD SAMARITAN HOMECARE AGENCY
Entity type:Organization
Organization Name:GOOD SAMARITAN HOMECARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:LASHAUN
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-222-1115
Mailing Address - Street 1:624 W 85TH ST
Mailing Address - Street 2:SU. 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-5860
Mailing Address - Country:US
Mailing Address - Phone:424-222-1115
Mailing Address - Fax:323-455-0480
Practice Address - Street 1:624 W 85TH ST
Practice Address - Street 2:SU. 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-5860
Practice Address - Country:US
Practice Address - Phone:424-222-1115
Practice Address - Fax:323-455-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health