Good Samaritan Adult Day Care

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

GOOD SAMARITAN ADULT DAY CARE

Practice address

473 Kindale Park Rd
Kingstree, SC 29556-5182

Phone

(843) 382-2966

Fax

(843) 382-2298

NPI assigned

Jul 16, 2019

Last updated

Jul 16, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Stephanie Ann Pendergrass

Title

Owner

Phone

(843) 382-2966

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

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

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563235200000",
    "number": "1467004705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 KINDALE PARK RD",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295565182",
            "telephone_number": "843-382-2966",
            "fax_number": "843-382-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 KINDALE PARK RD",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "295565182",
            "telephone_number": "843-382-2966",
            "fax_number": "843-382-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN ADULT DAY CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-16",
        "last_updated": "2019-07-16",
        "status": "A",
        "authorized_official_last_name": "PENDERGRASS",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-382-2966",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "goodsamaritanadc@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email address",
            "address_1": "473 Kindale Park Rd",
            "city": "Kingstree",
            "state": "SC",
            "country_code": "US",
            "postal_code": "295565182",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Jafer Nasser Gheraibeh, M.D.
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• Domonique Jones Goode
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• Dexter Graham

• Adult Day Care Clinic/Center in Kingstree, SC
• Providers in Kingstree, SC by specialty
• Adult Day Care Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2019; 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.