Healthcare Provider Details

I. General information

NPI: 1407462104
Provider Name (Legal Business Name): GOOD SAM HEALING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2020
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 S CHESTER AVE
BAKERSFIELD CA
93304-3648
US

IV. Provider business mailing address

901 OLIVE DR
BAKERSFIELD CA
93308-4137
US

V. Phone/Fax

Practice location:
  • Phone: 661-903-5555
  • Fax:
Mailing address:
  • Phone: 661-903-5555
  • Fax: 661-215-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MINTY DILLON
Title or Position: CEO
Credential:
Phone: 661-215-7500