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General NPI Number Information
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NPI Number | 1962528422
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Entity Type | Organization
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Legal Business Name | GOOD SAMARITAN HEALTH GROUP, INC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 32900 DETROIT RD
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City | AVON
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State | OH
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Zip | 44011-2018
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Country | US
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Telephone | 440-937-6201
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Fax | 440-937-5955
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Provider Business Mailing Address
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Address Line | 32900 DETROIT RD
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City | AVON
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State | OH
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Zip | 44011-2018
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Country | US
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Telephone | 440-937-6201
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Fax | 440-937-5955
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. WILLIAM SHACKLEFORD
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Credential | LNHA
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Telephone | 440-937-6201
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1195N
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License Number State | OH
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