Healthcare Provider Details

I. General information

NPI: 1366863458
Provider Name (Legal Business Name): GOOD SAMARITAN HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 W RUSSELL RD SUITE 170
LAS VEGAS NV
89118-1888
US

IV. Provider business mailing address

6825 W RUSSELL RD SUITE 170
LAS VEGAS NV
89118-1888
US

V. Phone/Fax

Practice location:
  • Phone: 702-896-8400
  • Fax: 702-791-5600
Mailing address:
  • Phone: 702-896-8400
  • Fax: 702-791-5600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number20061102960
License Number StateNV

VIII. Authorized Official

Name: LUNA PARAGAS
Title or Position: CLINIC ADMINISTRATOR
Credential: RN
Phone: 702-896-8400