Healthcare Provider Details

I. General information

NPI: 1790373686
Provider Name (Legal Business Name): THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2021
Last Update Date: 01/06/2021
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2304 LAUREL ST
TYNDALL SD
57066-2214
US

IV. Provider business mailing address

2304 LAUREL ST
TYNDALL SD
57066-2214
US

V. Phone/Fax

Practice location:
  • Phone: 605-589-3350
  • Fax: 605-589-3686
Mailing address:
  • Phone: 605-589-3350
  • Fax: 605-589-3686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIC VANDEN HULL
Title or Position: VICE PRESIDENT, FINANCE
Credential:
Phone: 605-362-5510