Provider Demographics
NPI:1639980733
Name:GOOD SAMARITAN SENIOR HOME LLC
Entity type:Organization
Organization Name:GOOD SAMARITAN SENIOR HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETELHEM
Authorized Official - Middle Name:B
Authorized Official - Last Name:MENKIR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:206-496-5334
Mailing Address - Street 1:31625 51ST AVE S
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98001-3810
Mailing Address - Country:US
Mailing Address - Phone:253-939-5751
Mailing Address - Fax:253-939-6927
Practice Address - Street 1:31625 51ST AVE S
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98001-3810
Practice Address - Country:US
Practice Address - Phone:253-939-5751
Practice Address - Fax:253-939-6927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty