MEDICARE: THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BN1400X	Nursing Facility Supplies (DME)
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
3	253Z00000X	In Home Supportive Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000100129001	OTHER	ID	REGENCE
2	01123	OTHER	ID	BC - IDAHO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053392548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Provider Business Mailing Address
First Line	:	PO BOX 5038
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57117-5038
Country	:	US
Telephone Number	:	605-362-3100
Fax Number	:	605-362-3265

Provider Business Practice Location Address
First Line	:	129 E 50TH ST
Second Line	:
City	:	GARDEN CITY
State	:	ID
Zip	:	83714-2407
Country	:	US
Telephone Number	:	208-333-2180
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MS. RAYE NAE NYLANDER
Credential	:
Telephone Number	:	605-362-3100

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	06/03/2024

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