Healthcare Provider Details

I. General information

NPI: 1518047570
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 7TH AVE
DEVILS LAKE ND
58301
US

IV. Provider business mailing address

4800 W 57TH ST
SIOUX FALLS SD
57117-5038
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-6580
  • Fax:
Mailing address:
  • Phone: 605-362-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. RAYE NAE NYLANDER
Title or Position: VICE PRESIDENT , CFO
Credential:
Phone: 605-362-3100