Healthcare Provider Details

I. General information

NPI: 1699757005
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2005
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN AVE
NOONAN ND
58765-0069
US

IV. Provider business mailing address

PO BOX 5038
SIOUX FALLS SD
57117-5038
US

V. Phone/Fax

Practice location:
  • Phone: 701-925-5670
  • Fax: 701-925-5718
Mailing address:
  • Phone: 605-362-3100
  • Fax: 605-362-3265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

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