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NPI Code Detail

MEDICARE: THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

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 License Number License Number State
1332BN1400XNursing Facility Supplies (DME)
2332BP3500XParenteral & Enteral Nutrition Supplies (DME)
3314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2NM00M095OTHERNMBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1396726063
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Provider Business Mailing Address
First Line : 4800 WEST 57TH STREET P.O. 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 : 3101 NORTH FLORIDA AVENUE
Second Line :
City : ALAMOGORDO
State : NM
Zip : 88310-9713
Country : US
Telephone Number : 505-434-0033
Fax Number : 505-434-0975
Authorized Official
Title or Position : CFO
Name : MS. RAYE NAE NYLANDER
Credential :
Telephone Number : 605-362-3100
Provider Enumeration Date : 11/09/2005
Last Update Date : 09/02/2025

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Directions to “THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY ” Practice Location

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