Good Samaritan Society HCBS-TX, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

GOOD SAMARITAN SOCIETY HCBS-TX, LLC

Practice address

607 W Magnolia Ave Ste 206
Ft Worth, TX 76104-4608

Phone

(817) 268-2643

Fax

(877) 787-9289

NPI assigned

Jun 25, 2006

Organization subpart

No

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

Authorized official

Name

Eric Vanden Hull

Title

VP, Finance

Phone

(605) 362-5510

Specialties & licenses 1

Addresses

Other names 1

• Good Samaritan Society- Hospice Doing business as

Electronic endpoints 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• The Evangelical Lutheran Good Samaritan Society

  • Skilled Nursing Facility
  • Sioux Falls, SD
  • NPI 1952385015

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632096000000",
    "number": "1699701045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 W MAGNOLIA AVE STE 206",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761044608",
            "telephone_number": "817-268-2643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W MAGNOLIA AVE STE 206",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761044608",
            "telephone_number": "817-268-2643",
            "fax_number": "877-787-9289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SAMARITAN SOCIETY HCBS-TX, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "last_updated": "2021-09-20",
        "certification_date": "2021-09-20",
        "status": "A",
        "authorized_official_last_name": "VANDEN HULL",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VP, FINANCE",
        "authorized_official_telephone_number": "605-362-5510"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Good Samaritan Society- Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Tori Gooden, DO

• All providers in Ft Worth, TX
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2021; 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.