# THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
- **Other names:** Good Samaritan Society - Four Corners Village
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568443570
- **Legal business name:** THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
- **Authorized official:** MRS. RAYE NAE NYLANDER (CFO)
- **Authorized official phone:** (605) 362-3100

## Contact information

- **Practice address:** 500 CARE LN, AZTEC, NM 87410-1552
- **Practice address phone:** (505) 334-9445
- **Practice address fax:** (505) 334-9577
- **Mailing address:** PO BOX 5038, SIOUX FALLS, SD 57117-5038
- **Mailing address phone:** (605) 362-3100
- **Mailing address fax:** (605) 362-3265

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |
| 332BN1400X | Nursing Facility Supplies (DME) | — | NULL | — |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | NULL | — |

## Other

- **Enumeration date:** 11/07/2005
- **Last updated:** 01/17/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | I0308 | — | NM |
| 01 | — | NM00M005 | BLUE CROSS BLUE SHIELD | NM |