Provider Demographics
NPI:1154565141
Name:GOOD SAMARITAN AGENCY
Entity type:Organization
Organization Name:GOOD SAMARITAN AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GIGUERE
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:207-942-7211
Mailing Address - Street 1:100 RIDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2652
Mailing Address - Country:US
Mailing Address - Phone:207-942-7211
Mailing Address - Fax:207-990-0851
Practice Address - Street 1:100 RIDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-2652
Practice Address - Country:US
Practice Address - Phone:207-942-7211
Practice Address - Fax:207-990-0851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS5224251B00000X
MELS6833251B00000X
MELS5190251B00000X
MELS1479251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101800100Medicaid