# GOOD SAMARITAN SUPPORTED LIVING, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124547146
- **Authorized official:** MARIA THERESA YEBRA VILLANUEVA RN (RN MANAGER)
- **Authorized official phone:** (614) 893-0579

## Contact information

- **Practice address:** 616 MAWYER DR, COLUMBUS, OH 43085-5403
- **Practice address phone:** (614) 893-0579
- **Mailing address:** 616 MAWYER DR, COLUMBUS, OH 43085-5403

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | 318641 | OH | — |
| 163W00000X | Registered Nurse | — | NULL | — |
| 163W00000X | Registered Nurse | — | — | — |
| 164W00000X | Licensed Practical Nurse | — | NULL | — |
| 164W00000X | Licensed Practical Nurse | — | — | — |
| 3747A0650X | Attendant Care Provider | — | NULL | Yes |
| 3747A0650X | Attendant Care Provider | — | — | Yes |
| 3747P1801X | Personal Care Attendant | — | NULL | — |
| 3747P1801X | Personal Care Attendant | — | — | — |
| 374U00000X | Home Health Aide | — | NULL | — |
| 374U00000X | Home Health Aide | — | — | — |

## Other

- **Enumeration date:** 09/11/2017
- **Last updated:** 09/11/2017