Healthcare Provider Details

I. General information

NPI: 1144414954
Provider Name (Legal Business Name): EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 S GARFIELD AVE
LOVELAND CO
80537-7377
US

IV. Provider business mailing address

2101 S GARFIELD AVE
LOVELAND CO
80537-7377
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-3100
  • Fax: 970-663-4526
Mailing address:
  • Phone: 970-669-3100
  • Fax: 970-663-4526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLYN TANDE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 970-669-3100