MEDICARE: GOOD SAMARITAN HEALTHCARE, LLC

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	225100000X	Physical Therapist	0535	NV
2	225100000X	Physical Therapist	1786	NV

General Provider Information

NPI Number	:	1629138219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN HEALTHCARE, LLC

Provider Business Mailing Address
First Line	:	5693 S JONES BLVD STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1967
Country	:	US
Telephone Number	:	702-896-8400
Fax Number	:	702-791-5600

Provider Business Practice Location Address
First Line	:	5693 S JONES BLVD STE 118
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-1967
Country	:	US
Telephone Number	:	702-406-6604
Fax Number	:	702-791-5600

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MARETES GODINEZ
Credential	:
Telephone Number	:	725-333-7121

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	09/13/2024

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Directions to “GOOD SAMARITAN HEALTHCARE, LLC ” Practice Location

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