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	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NH0201	OTHER	MN	UCARE
2	040909001	OTHER	MN	PRIME WEST
3	7100091	OTHER	MN	PMAP
4	1026620	OTHER	MN	PREFERRED ONE
5	5A17HO	OTHER	MN	BLUE CROSS BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689655086
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	:	413 13TH AVE
Second Line	:
City	:	HOWARD LAKE
State	:	MN
Zip	:	55349-9409
Country	:	US
Telephone Number	:	320-543-3800
Fax Number	:	320-543-2305

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	10/25/2021

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

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