Healthcare Provider Details

I. General information

NPI: 1205880663
Provider Name (Legal Business Name): GOOD SAMARITAN NURSING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E BELVEDERE AVE
BALTIMORE MD
21239-3004
US

IV. Provider business mailing address

1601 E BELVEDERE AVE
BALTIMORE MD
21239-3004
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-5600
  • Fax: 410-532-8141
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number30051
License Number StateMD

VIII. Authorized Official

Name: DEANA L STOUT
Title or Position: VP FINANCE
Credential:
Phone: 443-444-3841