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General NPI Number Information
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NPI Number | 1952309528
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HOSPITAL
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 06/03/2015
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Provider Practice Location Address
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Address Line | 611 E MAIN ST SUITE 110
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City | PETERSBURG
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State | IN
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Zip | 47567-1267
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Country | US
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Telephone | 812-354-8785
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Fax | 812-354-8786
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Provider Business Mailing Address
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Address Line | 515 BAYOU ST
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City | VINCENNES
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State | IN
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Zip | 47591-1034
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Country | US
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Telephone | 812-886-6800
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Fax | 812-886-6809
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Authorized Official
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Title or Position | VP BEHAVIORAL HEALTH/SPEC PROJECTS
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Name | MR. JOHN MANNING
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Credential |
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Telephone | 812-886-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 4030
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4030
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4030
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4030
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License Number State | IN
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Taxonomy #5
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 4030CMHC
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License Number State | IN
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