Provider Demographics
NPI:1306144498
Name:GOOD SAMARITAN HOME CARE, LLC
Entity type:Organization
Organization Name:GOOD SAMARITAN HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DENET
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-459-3939
Mailing Address - Street 1:304 S LOWRY ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3415
Mailing Address - Country:US
Mailing Address - Phone:615-459-3939
Mailing Address - Fax:615-459-3939
Practice Address - Street 1:304 S LOWRY ST
Practice Address - Street 2:SUITE C
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3415
Practice Address - Country:US
Practice Address - Phone:615-459-3939
Practice Address - Fax:615-459-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000007911253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care