Provider Demographics
NPI:1982713855
Name:GOOD SAMARITAN HOSPICE, INC.
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ASST. ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NADINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODE
Authorized Official - Suffix:
Authorized Official - Credentials:RN/ADMINSTRATOR
Authorized Official - Phone:580-668-3138
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:OK
Mailing Address - Zip Code:73463-0297
Mailing Address - Country:US
Mailing Address - Phone:580-668-3137
Mailing Address - Fax:580-668-3143
Practice Address - Street 1:410 IDLEWOOD CIRCLE
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:OK
Practice Address - Zip Code:73463
Practice Address - Country:US
Practice Address - Phone:580-668-3138
Practice Address - Fax:580-668-3143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4106251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK371568Medicare ID - Type Unspecified