Provider Demographics
NPI:1366046724
Name:GOODSAMARITAN HOME CARE
Entity type:Organization
Organization Name:GOODSAMARITAN HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAHIYE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-405-8308
Mailing Address - Street 1:122 23RD ST S STE F1
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1300
Mailing Address - Country:US
Mailing Address - Phone:619-405-8308
Mailing Address - Fax:
Practice Address - Street 1:122 23RD ST S STE F1
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1300
Practice Address - Country:US
Practice Address - Phone:619-405-8308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health