Organization
GOOD SAMARITAN HOSPICE USA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACKIE RANDOLPH GIST (PRESIDENT)
(256) 767-4799
Entity
Organization
Contact information
Practice address
402 E DR HICKS BLVD, FLORENCE, AL 35630-5763
(256) 767-4799
(256) 767-4798
Mailing address
402 E DR HICKS BLVD, FLORENCE, AL 35630-5763
(256) 767-4799
(256) 767-4798
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
12948
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01200654
BLUE CROSS ALABAMA
AL
05
—
PIC1595E
—
AL
Enumeration date
07/23/2006
Last updated
06/26/2008
Update your record
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