Organization
THE GOOD SAMARITAN HOUSE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JACQUELINE LORRAINE LOUISSAINT (VICE PRESIDENT)
(833) 472-6274
Entity
Organization
Contact information
Practice address
6959 S MARTLET DR, TUCSON, AZ 85756-8621
(833) 472-6274
Mailing address
6959 S MARTLET DR, TUCSON, AZ 85756-8621
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
251B00000X
Case Management Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QA0600X
Adult Day Care Clinic/Center
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QR0400X
Rehabilitation Clinic/Center
—
—
332800000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
—
—
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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