Good Samaritan Pontiac

LBN: Good Samaritan Pontiac
Good Samaritan Pontiac is an health care organization with primary practice located at 1225 S Ewing Dr , Pontiac IL 61764-9701. The organization recently has 2 registered licenses in different health care specialties including Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility, Nursing & Custodial Care Facilities / Skilled Nursing Facility. Nursing & Custodial Care Facilities / Skilled Nursing Facility is the primary health care specialty. Good Samaritan Pontiac can be contacted via phone (815) 844-5121, or through Wittenberg, Kim via phone (815) 844-5121.

Contact Information

Primary practice address
1225 S Ewing Dr Pontiac IL 61764-9701
Phone: (815) 844-5121
Fax: (815) 419-6000
Website:
Map and Directions
Authorized official contact:
Name: Wittenberg, Kim Registered Nurse (RN)
Phone: (815) 844-5121

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Nursing Facility/Intermediate Care Facility 313M00000X 1630299 Illinois
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 1630299 Illinois

Profile Details

NPI number 1881679579
LBN Legal business name Good Samaritan Pontiac
DBA Doing business as
Authorized official Wittenberg, Kim Registered Nurse (RN)
Entity Organization
Organization subpart 1 No
Enumeration date Dec 14th, 2005
Last updated Aug 12th, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881679579 NPPES
Illinois MEDICAID 0010942

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