Provider Demographics
NPI:1548268923
Name:GOOD SAMARITAN HOSPICE, INC.
Entity type:Organization
Organization Name:GOOD SAMARITAN HOSPICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-776-0198
Mailing Address - Street 1:2408 ELECTRIC RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3523
Mailing Address - Country:US
Mailing Address - Phone:540-776-0198
Mailing Address - Fax:540-776-0841
Practice Address - Street 1:4751 COVE ROAD NW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24017
Practice Address - Country:US
Practice Address - Phone:540-776-0198
Practice Address - Fax:540-776-0841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA051915251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA491510Medicare Oscar/Certification