Healthcare Provider Details

I. General information

NPI: 1902427644
Provider Name (Legal Business Name): SAMARITAN HEALTH AND WELLNESS CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 DEL PRADO BLVD S STE 100
CAPE CORAL FL
33990-3780
US

IV. Provider business mailing address

643 CAPE CORAL PKWY E STE B
CAPE CORAL FL
33904-8549
US

V. Phone/Fax

Practice location:
  • Phone: 239-360-7520
  • Fax:
Mailing address:
  • Phone: 239-257-3094
  • Fax: 239-471-2870

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SUSAN KAY HOOK
Title or Position: EXECUTIVE DIRECTOR
Credential: DNP, APRN, BC
Phone: 239-257-3094