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GOOD SAMARITAN HOSPITAL

Addiction Substance Use Disorder

Vincennes, Indiana

Provider NPI: 1861490435

Organization Information:
Organization Name:  GOOD SAMARITAN HOSPITAL
Organization is Subpart
Authorized Official:  JOHN  MANNING  VP BEHAVIORAL HEALTH/SPEC PROJECTS  812-8866800

Practice Location:
121 BUNTIN ST  VINCENNES, IN 47591 US
Tel: 812-885-2700  Fax: 812-885-2716

Business Mailing Address:
515 BAYOU ST  VINCENNES, IN 47591 US
Tel: 812-886-6800  Fax: 812-886-6809

Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
IN4030
N104100000XBehavioral Health & Social Service Providers
Social Worker
IN4030
N1041C0700XBehavioral Health & Social Service Providers
Social Worker
IN4030
Y251S00000XAgencies
Community/Behavioral Health
IN4030CMHC

Other Provider Identifiers:

IssuerNumberStateType
VALUE OPTIONS326003IN01
ANTHEM PIN FOR THIS LOCATION000000574042IN01
MHN GROUP165526IN01
100270140MIN05
100270140GIN05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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