Healthcare Provider Details

I. General information

NPI: 1487166120
Provider Name (Legal Business Name): GOOD SAMARITAN SHELTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 EAST TUNNELL STREET
SANTA MARIA CA
93454
US

IV. Provider business mailing address

412 EAST TUNNELL STREET
SANTA MARIA CA
93454
US

V. Phone/Fax

Practice location:
  • Phone: 805-925-0315
  • Fax: 866-594-7933
Mailing address:
  • Phone: 805-925-0315
  • Fax: 866-594-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. DONNA MICHELL FLORES
Title or Position: DIRECTOR OF TREATMENT
Credential: CADTP/CAODC
Phone: 805-266-3747