Provider Demographics
NPI:1194089243
Name:GOOD SAMARITAN HOME COMPANION SERVICES, INC.
Entity type:Organization
Organization Name:GOOD SAMARITAN HOME COMPANION SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FIELD
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-215-5900
Mailing Address - Street 1:PO BOX 962
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32067
Mailing Address - Country:US
Mailing Address - Phone:904-215-5900
Mailing Address - Fax:904-215-5980
Practice Address - Street 1:3689 MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068
Practice Address - Country:US
Practice Address - Phone:904-215-5900
Practice Address - Fax:904-215-5980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230249253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL230249OtherHOMEMAKER COMPANION