=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306992276
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAMARITANS OF AMERICAN MEDICAL SYSTEM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8800 S MAIN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77025-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-661-0001
-----------------------------------------------------
Fax | 713-669-4862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8800 S MAIN ST
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77025-2722
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-661-0001
-----------------------------------------------------
Fax | 713-669-4862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. IFAYEMI ODUTAYO
-----------------------------------------------------
Credential | B.S., RN
-----------------------------------------------------
Telephone | 713-661-0001
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 117767
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------