Organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - Boise Village
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
129 E 50TH ST, GARDEN CITY, ID 83714-2407
(208) 333-2180
Mailing address
PO BOX 5038, SIOUX FALLS, SD 57117-5038
(605) 362-3100
(605) 362-3265
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
332BN1400X
Nursing Facility Supplies (DME)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000100129001
REGENCE
ID
05
—
000371800
—
ID
01
—
01123
BC - IDAHO
ID
01
—
805490400
MEDICAID ID - TBI PROGRAM
ID
Enumeration date
11/10/2005
Last updated
06/03/2024
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