Provider Demographics
NPI:1952643413
Name:GOOD SAMARITAN HEALTHCARE
Entity type:Organization
Organization Name:GOOD SAMARITAN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARETES
Authorized Official - Middle Name:
Authorized Official - Last Name:GODINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-542-5610
Mailing Address - Street 1:6825 W RUSSELL RD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89118-1888
Mailing Address - Country:US
Mailing Address - Phone:702-896-8400
Mailing Address - Fax:702-791-5600
Practice Address - Street 1:6825 W RUSSELL RD
Practice Address - Street 2:SUITE 170
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1888
Practice Address - Country:US
Practice Address - Phone:702-896-8400
Practice Address - Fax:702-791-5600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-22
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV294509Medicare Oscar/Certification