Provider Demographics
NPI:1487166120
Name:GOOD SAMARITAN SHELTER
Entity type:Organization
Organization Name:GOOD SAMARITAN SHELTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF TREATMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MICHELL
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:CADTP/CAODC
Authorized Official - Phone:805-266-3747
Mailing Address - Street 1:412 EAST TUNNELL STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454
Mailing Address - Country:US
Mailing Address - Phone:805-925-0315
Mailing Address - Fax:866-594-7933
Practice Address - Street 1:412 EAST TUNNELL STREET
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454
Practice Address - Country:US
Practice Address - Phone:805-925-0315
Practice Address - Fax:866-594-7933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN SHELTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-03
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty