Provider Demographics
NPI:1538579669
Name:GOOD SAMARITAN LIVING WELL ASSISTED LIVING
Entity type:Organization
Organization Name:GOOD SAMARITAN LIVING WELL ASSISTED LIVING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:LAMY
Authorized Official - Last Name:LIMITE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:480-274-7815
Mailing Address - Street 1:2440 E WHITTEN ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-2832
Mailing Address - Country:US
Mailing Address - Phone:480-274-7815
Mailing Address - Fax:480-963-4367
Practice Address - Street 1:2440 E WHITTEN ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-2832
Practice Address - Country:US
Practice Address - Phone:480-274-7815
Practice Address - Fax:480-963-4367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No253Z00000XAgenciesIn Home Supportive Care