Healthcare Provider Details

I. General information

NPI: 1538579669
Provider Name (Legal Business Name): GOOD SAMARITAN LIVING WELL ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 E WHITTEN ST
CHANDLER AZ
85225-2832
US

IV. Provider business mailing address

2440 E WHITTEN ST
CHANDLER AZ
85225-2832
US

V. Phone/Fax

Practice location:
  • Phone: 480-274-7815
  • Fax: 480-963-4367
Mailing address:
  • Phone: 480-274-7815
  • Fax: 480-963-4367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: RACHELLE LAMY LIMITE
Title or Position: MANAGER
Credential: ADMINISTRATOR
Phone: 480-274-7815