Good Samaritan House of Granite City, Inc

Primary specialty

Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X

License

149.019998 Issued in IL

Legal business name

GOOD SAMARITAN HOUSE OF GRANITE CITY, INC

Practice address

1825 Delmar Ave
Granite City, IL 62040-4508

Phone

(618) 876-0607

NPI assigned

Jun 14, 2018

Organization subpart

No

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

Authorized official

Name

Ms. Latosha R Davis, LCSW

Title

Executive Director

Phone

(618) 219-9513

Specialties & licenses 3

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Aletha Ann Hogan, L.P.N.

  • Licensed Practical Nurse
  • Granite City, IL
  • NPI 1134362536
  NPD (past)

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

{
    "created_epoch": "1528934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528934400000",
    "number": "1134612054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1825 DELMAR AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404508",
            "telephone_number": "618-876-0607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 DELMAR AVE",
            "city": "GRANITE CITY",
            "state": "IL",
            "postal_code": "620404508",
            "telephone_number": "618-876-0607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN HOUSE OF GRANITE CITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-14",
        "last_updated": "2018-06-14",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LATOSHA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "618-219-9513",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "IL",
            "license": "149.019998",
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "IL",
            "license": "149.019998",
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "IL",
            "license": "149.019998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Gilbreth
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• Alan Richard Gitersonke, DPM
• Glorious Beginnings Doula Services
• Erin Marie Goebel, RN PHRN
• Krista L Gooding, PT
• Granite City Chiropractic LLC
• Granite City Clinic Corp
• Granite City Clinic Corp
• Granite City Emergency Physicians LLC

• Adolescent and Children Mental Health Clinic/Center in Granite City, IL
• Providers in Granite City, IL by specialty
• Adolescent and Children Mental Health Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2018; 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.