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General NPI Number Information
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NPI Number | 1710121850
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Entity Type | Organization
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Legal Business Name | SAMARITAN HEALTHCARE PROFESSIONALS, LLC
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Dates
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Enumeration Date | 04/20/2009
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 5729 IRONSTONE DR
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City | COLUMBUS
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State | GA
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Zip | 31907-5758
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Country | US
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Telephone | 706-221-8230
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Fax |
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Provider Business Mailing Address
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Address Line | 5729 IRONSTONE DR
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City | COLUMBUS
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State | GA
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Zip | 31907-5758
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. YVONNE RUSH
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Credential |
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Telephone | 706-221-8230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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