Good Samaritan Residential Care LLC

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

GOOD SAMARITAN RESIDENTIAL CARE LLC

Practice address

1536 E Inouye Dr
Casa Grande, AZ 85122-6590

Phone

(817) 480-3474

NPI assigned

Jul 22, 2022

Last updated

Jul 22, 2022By 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

Didier Twagirayezu

Title

Administrator

Phone

(817) 480-3474

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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

{
    "created_epoch": "1658448000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658448000000",
    "number": "1508591561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1536 E INOUYE DR",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851226590",
            "telephone_number": "817-480-3474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1536 E INOUYE DR",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851226590",
            "telephone_number": "817-480-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN RESIDENTIAL CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-22",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A",
        "authorized_official_last_name": "TWAGIRAYEZU",
        "authorized_official_first_name": "DIDIER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "817-480-3474"
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZDHS",
            "identifier": "BH7786",
            "state": "AZ"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "SECUREPORTAL",
            "affiliation": "N",
            "address_1": "1536 E Inouye Dr",
            "city": "Casa Grande",
            "state": "AZ",
            "country_code": "US",
            "postal_code": "851226590",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Mental Illness Community Based Residential Treatment Facility in Casa Grande, AZ
• Providers in Casa Grande, AZ by specialty
• Mental Illness Community Based Residential Treatment Facility in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; 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.