Healthcare Provider Details

I. General information

NPI: 1952643413
Provider Name (Legal Business Name): GOOD SAMARITAN HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
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 Number
License Number State

VIII. Authorized Official

Name: MARETES GODINEZ
Title or Position: MANAGING PARTNER
Credential:
Phone: 702-542-5610