Healthcare Provider Details

I. General information

NPI: 1710121850
Provider Name (Legal Business Name): SAMARITAN HEALTHCARE PROFESSIONALS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2009
Last Update Date: 04/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5729 IRONSTONE DR
COLUMBUS GA
31907-5758
US

IV. Provider business mailing address

5729 IRONSTONE DR
COLUMBUS GA
31907-5758
US

V. Phone/Fax

Practice location:
  • Phone: 706-221-8230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: MRS. YVONNE RUSH
Title or Position: ADMINISTRATOR
Credential:
Phone: 706-221-8230