# 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 - Lake Forest Village
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1740261742
- **Legal business name:** THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
- **Authorized official:** MR. JOEL FLUIT (VP, FINANCE)
- **Authorized official phone:** (605) 362-5416

## Contact information

- **Practice address:** 3901 MONTECITO DR, DENTON, TX 76210-5557
- **Practice address phone:** (940) 891-0856
- **Practice address fax:** (940) 891-2662
- **Mailing address:** 4800 W 57TH ST, SIOUX FALLS, SD 57108-2239
- **Mailing address phone:** (605) 323-3453

## Taxonomy

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

## Other

- **Enumeration date:** 11/08/2005
- **Last updated:** 07/19/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | HH2928 | BLUE CROSS BLUE SHIELD | TX |