Organization
GOOD SAMARITAN HOSPITAL
Active
Other names
MultiCare Good Samaritan Home Health
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R LONG MS,RN,CHCE,CDHP (PRESIDENT)
(253) 301-6400
Entity
Organization
Contact information
Practice address
3901 S FIFE ST, TACOMA, WA 98409-7309
(253) 301-6400
(253) 301-6528
Mailing address
PO BOX 5200, TACOMA, WA 98415-0200
(253) 301-6400
(253) 301-6528
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
IS302
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004
CHAMPUS HOME HEALTH
WA
01
—
0439370003
CIGNA MEDICARE
WA
01
—
1258
PREMERA
WA
05
—
9007618
—
WA
05
—
9166505
—
WA
01
—
GO1222
REGENCE HOME HEALTH
WA
01
—
WA2923
MOLINA
WA
Enumeration date
08/17/2005
Last updated
08/12/2009
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