Healthcare Provider Details

I. General information

NPI: 1740618305
Provider Name (Legal Business Name): GOOD SAMARITAN FOSTER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 12/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 W STROTHERS AVE
SEMINOLE OK
74868-3126
US

IV. Provider business mailing address

545 W STROTHERS AVE
SEMINOLE OK
74868-3126
US

V. Phone/Fax

Practice location:
  • Phone: 405-382-2434
  • Fax: 405-382-2406
Mailing address:
  • Phone: 405-382-2434
  • Fax: 405-382-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberK860051482
License Number StateOK

VIII. Authorized Official

Name: MR. ARUN JOSHUA MATHEW
Title or Position: CLINICAL DIRECTOR
Credential: LMSW, LCSW
Phone: 405-212-7466