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General NPI Number Information
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NPI Number | 1932181310
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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 | 11/18/2005
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 2885 COUNTRY DR STE 165
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City | LITTLE CANADA
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State | MN
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Zip | 55117-1097
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Country | US
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Telephone | 651-488-7680
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Fax | 651-488-7687
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Provider Business Mailing Address
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Address Line | 2885 COUNTRY DR STE 165
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City | LITTLE CANADA
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State | MN
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Zip | 55117-1097
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Country | US
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Telephone | 651-488-7680
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Fax | 651-488-7687
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Authorized Official
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Title or Position | CFO
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Name | MS. ERIC VANDENHULL
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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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