Healthcare Provider Details

I. General information

NPI: 1902889348
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SAINT PAUL ST
PRESTON MN
55965-0607
US

IV. Provider business mailing address

4800 WEST 57TH STREET P.O. BOX 5038
SIOUX FALLS SD
57117-5038
US

V. Phone/Fax

Practice location:
  • Phone: 605-362-3100
  • Fax:
Mailing address:
  • Phone: 605-362-3100
  • Fax: 605-362-3265

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. RAYE NAE NYLANDER
Title or Position: CFO
Credential:
Phone: 605-362-3100