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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
100784OTHERNEBLUE CROSS BLUE SHIELD
2F248048OTHERNEMIDLANDS CHOICE

General Provider Information

NPI Number : 1841271244
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 : 12856 DEAUVILLE DR
Second Line :
City : OMAHA
State : NE
Zip : 68137-3204
Country : US
Telephone Number : 402-895-2266
Fax Number : 402-895-8964
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 : 11/28/2021

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

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