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General NPI Number Information
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NPI Number | 1053010850
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN CARE PROVIDER LLC
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Dates
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Enumeration Date | 03/01/2023
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 442 SUNSET BLVD.
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City | HAYWARD
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State | CA
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Zip | 94541-3832
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Country | US
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Telephone | 209-406-6610
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Fax | 209-729-5777
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Provider Business Mailing Address
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Address Line | 442 SUNSET BLVD.
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City | HAYWARD
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State | CA
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Zip | 94541-3832
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Country | US
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Telephone | 209-406-6610
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Fax | 209-729-5777
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. PRAXEDES BERNARDO DEMESA
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Credential | LNHA
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Telephone | 209-406-6610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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