Healthcare Provider Details

I. General information

NPI: 1942024930
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPITAL CA LTD PTP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2024
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SANTA FE WAY
SHAFTER CA
93263-3158
US

IV. Provider business mailing address

901 OLIVE DR
BAKERSFIELD CA
93308-4144
US

V. Phone/Fax

Practice location:
  • Phone: 661-215-7500
  • Fax:
Mailing address:
  • Phone: 661-215-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GERRIE HALBROOK
Title or Position: CFO
Credential:
Phone: 661-215-7500