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General NPI Number Information
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NPI Number | 1134595515
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN SOCIETY SERVICES@HOME
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 2101 S GARFIELD AVE
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City | LOVELAND
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State | CO
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Zip | 80537-7377
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Country | US
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Telephone | 970-669-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 4800 W 57TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2239
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Country | US
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Telephone | 605-362-3100
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Fax |
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Authorized Official
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Title or Position | VP OPERATIONS- HCBS
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Name | KIM JOHANSEN
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Credential |
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Telephone | 605-362-3320
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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