Healthcare Provider Details

I. General information

NPI: 1497897391
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 LINDEN ST
SYRACUSE NE
68446-9797
US

IV. Provider business mailing address

4800 W 57TH ST
SIOUX FALLS SD
57108-2239
US

V. Phone/Fax

Practice location:
  • Phone: 402-269-7535
  • Fax: 402-269-3803
Mailing address:
  • Phone: 605-362-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living 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