Provider Demographics
NPI:1255376588
Name:GOOD SAMARITAN HOSPICE
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPICE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:P
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-566-6242
Mailing Address - Street 1:310 ALLSTON ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7659
Mailing Address - Country:US
Mailing Address - Phone:617-566-6242
Mailing Address - Fax:617-566-3055
Practice Address - Street 1:310 ALLSTON ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7659
Practice Address - Country:US
Practice Address - Phone:617-566-6242
Practice Address - Fax:617-566-3055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7218251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA702185OtherHARVARD PILGRIM
MA0604658Medicaid
MA800943OtherTUFTS HEALTH PLAN FO MA
MA224518OtherBLUE CROSS BLUE SHIELD
MA0604658Medicaid