Healthcare Provider Details

I. General information

NPI: 1134595515
Provider Name (Legal Business Name): GOOD SAMARITAN SOCIETY SERVICES@HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S GARFIELD AVE
LOVELAND CO
80537-7377
US

IV. Provider business mailing address

4800 W 57TH ST
SIOUX FALLS SD
57108-2239
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-3100
  • Fax:
Mailing address:
  • Phone: 605-362-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KIM JOHANSEN
Title or Position: VP OPERATIONS- HCBS
Credential:
Phone: 605-362-3320