Organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - Jeffersontown
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
MS. RAYE NAE NYLANDER (CFO)
(605) 362-3100
Entity
Organization
Contact information
Practice address
3500 GOOD SAMARITAN WAY, JEFFERSONTOWN, KY 40299-6117
(502) 267-7403
(502) 267-8978
Mailing address
4800 WEST 57TH STREET P.O. BOX 5038, SIOUX FALLS, SD 57117-5038
(605) 362-3100
(605) 362-3265
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000054394
BLUE CROSS BLUE SHIELD
KY
01
—
00000054394
ANTHEM BLUE CROSS BLUE SH
KY
05
—
12501466
—
KY
Enumeration date
11/09/2005
Last updated
12/27/2012
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