=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962775833
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOOD SAMARITAN HOSPICE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2012
-----------------------------------------------------
Last Update Date | 02/22/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1055 E TROPICANA AVE STE 270
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-6622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-646-0900
-----------------------------------------------------
Fax | 702-631-1212
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1055 E TROPICANA AVE STE 270
-----------------------------------------------------
City | LAS VEGAS
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89119-6622
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-646-0900
-----------------------------------------------------
Fax | 702-631-1212
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | ARLENE M JAOJOCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-646-0900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number | 6009HPC-0
-----------------------------------------------------
License Number State | NV
-----------------------------------------------------