Healthcare Provider Details

I. General information

NPI: 1053010850
Provider Name (Legal Business Name): GOOD SAMARITAN CARE PROVIDER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 SUNSET BLVD.
HAYWARD CA
94541-3832
US

IV. Provider business mailing address

442 SUNSET BLVD.
HAYWARD CA
94541-3832
US

V. Phone/Fax

Practice location:
  • Phone: 209-406-6610
  • Fax: 209-729-5777
Mailing address:
  • Phone: 209-406-6610
  • Fax: 209-729-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. PRAXEDES BERNARDO DEMESA
Title or Position: PRESIDENT
Credential: LNHA
Phone: 209-406-6610