Organization
GOOD SAMARITAN SUPPORTED LIVING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARIA THERESA YEBRA VILLANUEVA RN (RN MANAGER)
(614) 893-0579
Entity
Organization
Contact information
Practice address
616 MAWYER DR, COLUMBUS, OH 43085-5403
(614) 893-0579
Mailing address
616 MAWYER DR, COLUMBUS, OH 43085-5403
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
318641
OH
163W00000X
Registered Nurse
—
—
164W00000X
Licensed Practical Nurse
—
—
3747A0650X
Attendant Care Provider
Primary
—
—
3747P1801X
Personal Care Attendant
—
—
374U00000X
Home Health Aide
—
—
Other
Enumeration date
09/11/2017
Last updated
09/11/2017
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