Provider Demographics
NPI:1962775833
Name:GOOD SAMARITAN HOSPICE, INC.
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARLENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAOJOCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-646-0900
Mailing Address - Street 1:1055 E TROPICANA AVE STE 270
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6622
Mailing Address - Country:US
Mailing Address - Phone:702-646-0900
Mailing Address - Fax:702-631-1212
Practice Address - Street 1:1055 E TROPICANA AVE STE 270
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6622
Practice Address - Country:US
Practice Address - Phone:702-646-0900
Practice Address - Fax:702-631-1212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6009HPC-0251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based