Provider Demographics
NPI:1104816206
Name:GOOD SAMARITAN HOSPICE OF PITTSBURGH
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPICE OF PITTSBURGH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RONI
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-933-8888
Mailing Address - Street 1:116 BROWNS HILL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:PA
Mailing Address - Zip Code:16059-3142
Mailing Address - Country:US
Mailing Address - Phone:724-933-8888
Mailing Address - Fax:724-933-8844
Practice Address - Street 1:116 BROWNS HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:PA
Practice Address - Zip Code:16059-3142
Practice Address - Country:US
Practice Address - Phone:724-933-8888
Practice Address - Fax:724-933-8844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA16291600251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017449480001Medicaid
PA01744948Medicaid
PA01744948Medicaid