Healthcare Provider Details

I. General information

NPI: 1841272226
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: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 3RD ST NE STE A
DEVILS LAKE ND
58301-3015
US

IV. Provider business mailing address

PO BOX 5038
SIOUX FALLS SD
57117-5038
US

V. Phone/Fax

Practice location:
  • Phone: 844-247-1378
  • Fax: 218-773-0396
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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier54912
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer
# 2
Identifier98871
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBLUE CROSS BLUE SHIELD
# 3
Identifier34339
Identifier TypeOTHER
Identifier StateND
Identifier IssuerQUALIFIED PROVIDER SERVIC
# 4
Identifier3674
Identifier TypeOTHER
Identifier StateND
Identifier IssuerVA

VIII. Authorized Official

Name: MS. KIMBERLY JOHANSEN
Title or Position: CFO
Credential:
Phone: 605-362-3100