| NPI | 1114407574 |
|---|---|
| Former Legal Business Name | GOOD SAMARITAN VILLAGE LLLP |
| Entity Type | Organization |
| Authorized Contact | DERRICK APPIAH Member 203-558-4189 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities (Licence: FL 714547) |
| Enumeration Date | 2018-08-15 |
| Last Update Date | 2018-08-15 |