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General NPI Number Information
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NPI Number | 1497738520
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Entity Type | Organization
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Legal Business Name | THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
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Dates
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Enumeration Date | 11/22/2005
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 600 S 5TH ST STE 211
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City | SAINT PETER
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State | MN
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Zip | 56082-1496
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Country | US
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Telephone | 507-931-9021
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Fax | 507-931-9043
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Provider Business Mailing Address
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Address Line | PO BOX 5038
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City | SIOUX FALLS
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State | SD
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Zip | 57117-5038
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Country | US
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Telephone | 605-362-3100
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Fax | 605-362-3265
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Authorized Official
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Title or Position | CFO
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Name | MR. GRANT TRIBBLE
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Credential |
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Telephone | 605-362-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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