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General NPI Number Information
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NPI Number | 1588645600
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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 | 11/07/2005
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 3191 ASTER DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-3743
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Country | US
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Telephone | 928-443-9999
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Fax | 928-778-5251
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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 | MS. 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 | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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