MEDICARE: GOOD SAMARITAN NURSING HOME

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	376G00000X	Nursing Home Administrator		IL

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	:	1568483329
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN NURSING HOME

Provider Business Mailing Address
First Line	:	407 N HEBARD STREET
Second Line	:
City	:	KNOXVILLE
State	:	IL
Zip	:	61448
Country	:	US
Telephone Number	:	309-289-2614
Fax Number	:	309-289-8847

Provider Business Practice Location Address
First Line	:	407 N HEBARD STREET
Second Line	:
City	:	KNOXVILLE
State	:	IL
Zip	:	61448
Country	:	US
Telephone Number	:	309-289-2614
Fax Number	:	309-289-8847

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. LINDA D COOK
Credential	:	RN ADMINISTRATOR
Telephone Number	:	309-289-2614

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	08/22/2020

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Directions to “GOOD SAMARITAN NURSING HOME ” Practice Location

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