MEDICARE: GOOD SAMARITAN HOSPICE, INC.

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	251G00000X	Community Based Hospice Care Agency	051915	VA

General Provider Information

NPI Number	:	1548268923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN HOSPICE, INC.

Provider Business Mailing Address
First Line	:	2408 ELECTRIC RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3523
Country	:	US
Telephone Number	:	540-776-0198
Fax Number	:	540-776-0841

Provider Business Practice Location Address
First Line	:	4751 COVE ROAD NW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24017
Country	:	US
Telephone Number	:	540-776-0198
Fax Number	:	540-776-0841

Authorized Official
Title or Position	:	CEO
Name	:	MR. AARON HOUSH
Credential	:
Telephone Number	:	540-776-0198

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	06/14/2024

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