Organization
GOOD SAMARITAN HOSPITAL
Active
Organization
GOOD SAMARITAN HOSPITAL
Active
Other names
Good Samaritan Home Health & Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
KEN MCKINNEY MS,RN,CHCE,CDHP (DIRECTOR)
(253) 697-7600
Entity
Organization
Contact information
Practice address
1317 E MAIN, PUYALLUP, WA 98372-3136
(253) 697-7600
(253) 691-9598
Mailing address
PO BOX 1247, PUYALLUP, WA 98371-0192
(253) 697-7600
(253) 697-5191
Taxonomy
Speciality
Code
Description
License number
State
251F00000X
Home Infusion Agency
Primary
IS302
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004
CHAMPUS HOME HEALTH
WA
01
—
0543130001
CIGNA MEDICARE
WA
01
—
1258
PREMERA
WA
05
—
7330079
—
WA
01
—
GO4586
REGENCE HIT
WA
01
—
WA2923
MOLINA
WA
Enumeration date
08/22/2005
Last updated
08/22/2020
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