Provider Demographics
NPI:1699701045
Name:GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Entity type:Organization
Organization Name:GOOD SAMARITAN SOCIETY HCBS-TX, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEN HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-5510
Mailing Address - Street 1:607 W MAGNOLIA AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4608
Mailing Address - Country:US
Mailing Address - Phone:817-268-2643
Mailing Address - Fax:
Practice Address - Street 1:607 W MAGNOLIA AVE STE 206
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4608
Practice Address - Country:US
Practice Address - Phone:817-268-2643
Practice Address - Fax:877-787-9289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251G00000X
251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX671584Medicare Oscar/Certification