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	6009HPC-0	NV

General Provider Information

NPI Number	:	1962775833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD SAMARITAN HOSPICE, INC.

Provider Business Mailing Address
First Line	:	1055 E TROPICANA AVE STE 270
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6622
Country	:	US
Telephone Number	:	702-646-0900
Fax Number	:	702-631-1212

Provider Business Practice Location Address
First Line	:	1055 E TROPICANA AVE STE 270
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6622
Country	:	US
Telephone Number	:	702-646-0900
Fax Number	:	702-631-1212

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ARLENE M JAOJOCO
Credential	:
Telephone Number	:	702-646-0900

Provider Enumeration Date	:	02/22/2012
Last Update Date	:	02/22/2012

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