Basic Information
| Provider Information | |||||||||
| NPI: | 1063839843 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GOOD SAMARITAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 104 S C ST | ||||||||
| Address2: | A | ||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934366924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057360357 | ||||||||
| FaxNumber: | 8009699350 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 S C ST | ||||||||
| Address2: | A | ||||||||
| City: | LOMPOC | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934366924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057360357 | ||||||||
| FaxNumber: | 8009699350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | FLORES | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | MICHELLE | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF TREATMENT | ||||||||
| AuthorizedOfficialTelephone: | 8053468185 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | CA | N | Agencies | Community/Behavioral Health | 324500000X | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |
No ID Information.