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General NPI Number Information
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NPI Number | 1568749141
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Entity Type | Organization
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Legal Business Name | SAMARITIAN CARE, LLC
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Dates
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Enumeration Date | 11/09/2011
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 1227 AUGUSTA WEST PKWY SUITE 2
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City | AUGUSTA
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State | GA
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Zip | 30909-6670
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Country | US
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Telephone | 706-364-5158
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Fax | 706-364-5193
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Provider Business Mailing Address
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Address Line | PO BOX 16183
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City | AUGUSTA
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State | GA
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Zip | 30919-2183
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Country | US
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Telephone | 706-364-5158
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Fax | 706-364-5193
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Authorized Official
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Title or Position | CEO, OWNER
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Name | MR. JEFFERY K TOBIN
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Credential |
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Telephone | 803-300-6786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | LCB20100001349
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License Number State | GA
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