Healthcare Provider Details

I. General information

NPI: 1932181310
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2885 COUNTRY DR STE 165
LITTLE CANADA MN
55117-1097
US

IV. Provider business mailing address

2885 COUNTRY DR STE 165
LITTLE CANADA MN
55117-1097
US

V. Phone/Fax

Practice location:
  • Phone: 651-488-7680
  • Fax: 651-488-7687
Mailing address:
  • Phone: 651-488-7680
  • Fax: 651-488-7687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. ERIC VANDENHULL
Title or Position: CFO
Credential:
Phone: 605-362-3100