MEDICARE: GOOD SAMARITAN HOME HEALTH CARE LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043973613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN HOME HEALTH CARE LTD

Provider Business Mailing Address
First Line	:	5300 E MAIN ST STE 207
Second Line	:
City	:	WHITEHALL
State	:	OH
Zip	:	43213-2580
Country	:	US
Telephone Number	:	614-500-4408
Fax Number	:

Provider Business Practice Location Address
First Line	:	5300 E MAIN ST STE 207
Second Line	:
City	:	WHITEHALL
State	:	OH
Zip	:	43213-2580
Country	:	US
Telephone Number	:	614-500-4408
Fax Number	:	614-636-4920

Authorized Official
Title or Position	:	CEO
Name	:	DR. EMANUEL C NDUAGUBA
Credential	:	MD, RN
Telephone Number	:	614-668-5000

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	10/20/2021

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