Good Samaritan Care Provider LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GOOD SAMARITAN CARE PROVIDER LLC

Doing business as

Four Seasons in Paradise

Practice address

10740 Oakwilde Ave
Stockton, CA 95212-9249

Phone

(209) 406-6610

Fax

(209) 451-4997

NPI assigned

Nov 26, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Praxedes Bernardo Demesa, NHA

Title

President/Managing Member

Phone

(530) 877-7676

Specialties & licenses 1

Addresses

Other names 1

• FOUR SEASONS IN PARADISE Doing business as

Tax ID family

Four Seasons Care Center- Lodi2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Good Samaritan Care Provider LLC

  dba Four Seasons Care Center- Lodi

  • Skilled Nursing Facility
  • Stockton, CA
  • NPI 1114323136
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1416960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416960000000",
    "number": "1033516539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7419 SKYWAY",
            "city": "PARADISE",
            "state": "CA",
            "postal_code": "959693230",
            "telephone_number": "209-406-6610",
            "fax_number": "209-451-4997"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10740 OAKWILDE AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952129249",
            "telephone_number": "209-406-6610",
            "fax_number": "209-451-4997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN CARE PROVIDER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-26",
        "last_updated": "2014-11-26",
        "status": "A",
        "authorized_official_last_name": "DEMESA",
        "authorized_official_first_name": "PRAXEDES",
        "authorized_official_middle_name": "BERNARDO",
        "authorized_official_title_or_position": "PRESIDENT/MANAGING MEMBER",
        "authorized_official_telephone_number": "530-877-7676",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOUR SEASONS IN PARADISE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• VI Tran Gonzalez
• Vianey Gonzalez
• Yesenia Gonzalez
• Brindon D'Marlo Gooch
• Good Samaritan Care Choice Inc (Care Choice Post Acute)
• Good Samaritan Care Provider LLC (Four Seasons Care Center- Lodi)
• Good Samaritan Carechoice & Compliance Group LLC (A Good Samaritan Home- Barbados)
• Brell Moneece Goodlow
• Deja Makiya Goodlow
• Adam Anthony Goodwin, PT, DPT

• Skilled Nursing Facility in Stockton, CA
• Providers in Stockton, CA by specialty
• Skilled Nursing Facility in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.