Basic Information
| Provider Information | |||||||||
| NPI: | 1265422166 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GOOD SAMARITAN LUTHERAN HEALTH CARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4770 WHITE PLAINS RD | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104701104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189319700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 125 ROCKEFELLER RD | ||||||||
| Address2: | |||||||||
| City: | DELMAR | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120542221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184398116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | LEHMANN | ||||||||
| AuthorizedOfficialFirstName: | RAFI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5184398116 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 141777540 | NY | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 00308567 | 05 | NY | MEDICAID |