Healthcare Provider Details

I. General information

NPI: 1801119052
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 03/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 W 49TH ST STE 47
SIOUX FALLS SD
57106-1865
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 605-361-0891
  • Fax: 605-361-3059
Mailing address:
  • Phone:
  • Fax:

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:

VIII. Authorized Official

Name: RAYE NAE NYLANDER
Title or Position: CFO, TREASURER
Credential:
Phone: 605-362-3100