Healthcare Provider Details

I. General information

NPI: 1184886319
Provider Name (Legal Business Name): GOOD SAMARITAN HOMECARE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

624 W 85TH ST SU. 2
LOS ANGELES CA
90044-5860
US

IV. Provider business mailing address

624 W 85TH ST SU. 2
LOS ANGELES CA
90044-5860
US

V. Phone/Fax

Practice location:
  • Phone: 424-222-1115
  • Fax: 323-455-0480
Mailing address:
  • Phone: 424-222-1115
  • Fax: 323-455-0480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. YVETTE LASHAUN WASHINGTON
Title or Position: CEO
Credential:
Phone: 424-222-1115