Healthcare Provider Details

I. General information

NPI: 1255376588
Provider Name (Legal Business Name): GOOD SAMARITAN HOSPICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 ALLSTON ST
BRIGHTON MA
02135-7659
US

IV. Provider business mailing address

310 ALLSTON ST
BRIGHTON MA
02135-7659
US

V. Phone/Fax

Practice location:
  • Phone: 617-566-6242
  • Fax: 617-566-3055
Mailing address:
  • Phone: 617-566-6242
  • Fax: 617-566-3055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number7218
License Number StateMA

VIII. Authorized Official

Name: MR. LEO P SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: LICSW
Phone: 617-566-6242