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General NPI Number Information
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NPI Number | 1255376588
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HOSPICE
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Dates
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Enumeration Date | 06/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 310 ALLSTON ST
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City | BRIGHTON
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State | MA
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Zip | 02135-7659
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Country | US
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Telephone | 617-566-6242
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Fax | 617-566-3055
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Provider Business Mailing Address
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Address Line | 310 ALLSTON ST
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City | BRIGHTON
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State | MA
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Zip | 02135-7659
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Country | US
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Telephone | 617-566-6242
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Fax | 617-566-3055
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LEO P SMITH
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Credential | LICSW
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Telephone | 617-566-6242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 7218
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License Number State | MA
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