Healthcare Provider Details

I. General information

NPI: 1851344501
Provider Name (Legal Business Name): SAMARITAN FAMILY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 SALEM ST
BROOKVILLE OH
45309-8227
US

IV. Provider business mailing address

950 SALEM ST
BROOKVILLE OH
45309-8227
US

V. Phone/Fax

Practice location:
  • Phone: 937-833-4581
  • Fax: 937-833-5359
Mailing address:
  • Phone: 937-833-4581
  • Fax: 937-833-5359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KENNETH PRUNIER
Title or Position: CEO/PRESIDENT
Credential:
Phone: 937-208-8213