Provider Demographics
NPI:1104224153
Name:GOOD SAMARITAN RETIREMENT CENTER
Entity type:Organization
Organization Name:GOOD SAMARITAN RETIREMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:IRENE
Authorized Official - Last Name:SORENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-590-1515
Mailing Address - Street 1:1515 JAMACHA WAY
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92019-4123
Mailing Address - Country:US
Mailing Address - Phone:619-590-1515
Mailing Address - Fax:619-590-5200
Practice Address - Street 1:1515 JAMACHA WAY
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-4123
Practice Address - Country:US
Practice Address - Phone:619-590-1515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374600950310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility