Healthcare Provider Details

I. General information

NPI: 1013990142
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 TERRACE DR
LAS CRUCES NM
88011-5053
US

IV. Provider business mailing address

PO BOX 5038
SIOUX FALLS SD
57117-5038
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-2103
  • Fax: 575-556-2181
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: MR. JOEL FLUIT
Title or Position: VICE PRESIDENT, FINANCE
Credential:
Phone: 605-362-3100