MEDICARE: THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1851853816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Provider Business Mailing Address
First Line	:	4800 W 57TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2239
Country	:	US
Telephone Number	:	605-362-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	4080 W BROADWAY AVE STE 132
Second Line	:
City	:	ROBBINSDALE
State	:	MN
Zip	:	55422-5605
Country	:	US
Telephone Number	:	763-324-7924
Fax Number	:	763-208-6738

Authorized Official
Title or Position	:	VP - FINANCE
Name	:	ERIC VANDEN HULL
Credential	:
Telephone Number	:	605-362-5510

Provider Enumeration Date	:	04/01/2019
Last Update Date	:	07/15/2021

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