GOOD SAMARITAN CARE PROVIDER LLC (NPI# 1114323136) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114323136 |
| Entity Type | Organization |
| Organization Name | GOOD SAMARITAN CARE PROVIDER LLC |
| Other Organization Name | FOUR SEASONS CARE CENTER- LODI |
| Practice Address |
10740 Oakwilde Ave Stockton CA 95212-9249 |
| Mailing Address |
610 S Fairmont Ave Lodi CA 95240-3835 |
| Practice Telephone | 2094066610 |
| Practice Fax Number | 2094514997 |
| Mailing Telephone | 2093677400 |
| Mailing Fax Number | 2094514997 |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2014-11-19 |
| Authorized Official Name | MS. PRAXEDES BERNARDO DEMESA (PRESIDENT/MANAGNG MEMBER) |
| Authorized Official Telephone | 2094066610 |
| Authorized Official Credential | NHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| FOUR SEASONS CARE CENTER- LODI | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033516539 | Good Samaritan Care Provider LLC | Skilled Nursing Facility | 10740 Oakwilde Ave, Stockton, CA 95212-9249 | 2014-11-26 |
| Street Address |
10740 OAKWILDE AVE |
| City | STOCKTON |
| State | CA |
| Zip Code | 95212-9249 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033516539 | Good Samaritan Care Provider LLC | Skilled Nursing Facility | 10740 Oakwilde Ave, Stockton, CA 95212-9249 | 2014-11-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962046524 | Randy Sarnillo Morelos | Residential Treatment Facility, Physical Disabilities | 9152 Chianti Circle, Stockton, CA 95212 | 2019-11-06 |
| 1316494339 | Anka Behavioral Health, Inc. | Community/Behavioral Health | 9555 Priscilla Ln, Stockton, CA 95212 | 2016-09-07 |
| 1487058848 | Faith Isiderio | Physical Therapy Assistant | 5650 Patti Lynn Way, Stockton, CA 95212 | 2014-10-14 |
| 1124173448 | George T Lin | Dentist | 3459 Matterhorn Drive, Stockton, CA 95212 | 2007-01-25 |
| 1851395131 | Eric Chapa | Family Medicine | 5040 E Morada Ln, Stockton, CA 95212 | 2005-06-02 |
| 1114530250 | Heather Elizabeth Phillips | Licensed Psychiatric Technician | 4900 N Highway 99 Unit 68, Stockton, CA 95212-1007 | 2020-08-28 |
| 1396281507 | Kaitlend Tatiana Smith | Behavioral Analyst | 4899 Hildreth Ln, Stockton, CA 95212-1408 | 2017-01-11 |
| 1629489315 | Charles Vansicklen | Student in an Organized Health Care Education/Training Program | 8619 Emanuel Way, Stockton, CA 95212-1423 | 2014-05-15 |
| 1891853826 | Raleys | Pharmacy | 4255 E Morada Ln, Stockton, CA 95212-1600 | 2006-12-04 |
| 1881006351 | Phillip H Shin | Pharmacist | 4255 E Morada Ln, Stockton, CA 95212-1600 | 2014-06-02 |
| Find all providers in zip 95212 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316330152 | Waverly Place of Stockton, LLC | Skilled Nursing Facility | 501 E Front Avenue, Stockton, IL 61085 | 2015-03-17 |
| 1932507431 | Sandra Rae Divine | Skilled Nursing Facility | 1015 Lancaster Dr, Stockton, MO 65785-8360 | 2014-12-15 |
| 1801938816 | Covenant Care California, LLC | Skilled Nursing Facility | 9289 Branstetter Place, Stockton, CA 95209-1700 | 2007-02-13 |
| 1730269184 | O'connor Woods Housing Corp | Skilled Nursing Facility | 3110 Wagner Heights Rd, Stockton, CA 95209-4848 | 2006-10-17 |
| 1891700464 | Kindred Nursing Centers West, LLC | Skilled Nursing Facility | 1517 E Knickerbocker Dr, Stockton, CA 95210-3119 | 2006-07-30 |
| 1548283542 | Stockton Edison Healthcare Corporation | Skilled Nursing Facility | 1630 N. Edison St., Stockton, CA 95204 | 2006-07-25 |
| 1871512046 | Helios Healthcare, LLC | Skilled Nursing Facility | 442 E Hampton St, Stockton, CA 95204-5519 | 2006-07-19 |
| 1922027002 | Helios Healthcare, LLC | Skilled Nursing Facility | 6940 Pacific Ave, Stockton, CA 95207-2602 | 2006-07-19 |
| 1487601704 | Sunbridge Stockton Rehabilitation Center LLC | Skilled Nursing Facility | 9107 Davis Rd, Stockton, CA 95209-1807 | 2006-05-30 |
| 1679529176 | Beverly Health and Rehabilitation Services, Inc. | Skilled Nursing Facility | 1221 Rosemarie Ln, Stockton, CA 95207-6703 | 2006-05-26 |
| Find all providers in STOCKTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.