MEDICARE: GOOD SAMARITAN HOMECARE AGENCY

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	251E00000X	Home Health Agency		CA

General Provider Information

NPI Number	:	1184886319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN HOMECARE AGENCY

Provider Business Mailing Address
First Line	:	624 W 85TH ST
Second Line	:	SU. 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-5860
Country	:	US
Telephone Number	:	424-222-1115
Fax Number	:	323-455-0480

Provider Business Practice Location Address
First Line	:	624 W 85TH ST
Second Line	:	SU. 2
City	:	LOS ANGELES
State	:	CA
Zip	:	90044-5860
Country	:	US
Telephone Number	:	424-222-1115
Fax Number	:	323-455-0480

Authorized Official
Title or Position	:	CEO
Name	:	MS. YVETTE LASHAUN WASHINGTON
Credential	:
Telephone Number	:	424-222-1115

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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