MEDICARE: GOOD SAMARITAN SOCIETY HCBS-TX, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		TX

General Provider Information

NPI Number	:	1043450950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN SOCIETY HCBS-TX, LLC

Provider Business Mailing Address
First Line	:	700 N TOWN EAST BLVD APT 159
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-4793
Country	:	US
Telephone Number	:	972-686-4366
Fax Number	:	972-686-4372

Provider Business Practice Location Address
First Line	:	607 W MAGNOLIA AVE STE 205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4608
Country	:	US
Telephone Number	:	972-686-4366
Fax Number	:	972-686-4372

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. GEORGE GRANT TRIBBLE
Credential	:
Telephone Number	:	605-362-3900

Provider Enumeration Date	:	03/05/2009
Last Update Date	:	11/01/2021

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