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General NPI Number Information
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NPI Number | 1588091508
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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 | 10/04/2013
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 985 LINCOLN RD STE 324A
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City | BETTENDORF
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State | IA
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Zip | 52722-4156
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Country | US
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Telephone | 563-359-0522
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Fax | 563-359-0603
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Provider Business Mailing Address
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Address Line | 4800 W 57TH ST
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City | SIOUX FALLS
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State | SD
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Zip | 57108-2239
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | RAYE NAE NYLANDER
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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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