Provider Demographics
NPI:1053010850
Name:GOOD SAMARITAN CARE PROVIDER LLC
Entity type:Organization
Organization Name:GOOD SAMARITAN CARE PROVIDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PRAXEDES
Authorized Official - Middle Name:BERNARDO
Authorized Official - Last Name:DEMESA
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:209-406-6610
Mailing Address - Street 1:442 SUNSET BLVD.
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3832
Mailing Address - Country:US
Mailing Address - Phone:209-406-6610
Mailing Address - Fax:209-729-5777
Practice Address - Street 1:442 SUNSET BLVD.
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3832
Practice Address - Country:US
Practice Address - Phone:209-406-6610
Practice Address - Fax:209-729-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility