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
1	310400000X	Assisted Living Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972727071
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Provider Business Mailing Address
First Line	:	4800 W 57TH ST
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2239
Country	:	US
Telephone Number	:	605-362-3100
Fax Number	:

Provider Business Practice Location Address
First Line	:	840 E ELVA ST
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83401-2801
Country	:	US
Telephone Number	:	208-523-4795
Fax Number	:	208-522-9175

Authorized Official
Title or Position	:	VICE PRESIDENT, CFO
Name	:	RAYE NAE NYLANDER
Credential	:
Telephone Number	:	605-362-3100

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	06/18/2008

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

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