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	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942424940
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	:	508 W TRILBY RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-4054
Country	:	US
Telephone Number	:	970-226-4909
Fax Number	:	970-226-6976

Authorized Official
Title or Position	:	VICE PRESIDENT, CFO
Name	:	MRS. RAYE NAE NYLANDER
Credential	:
Telephone Number	:	605-362-3100

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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