Organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Capeside Cove Good Samaritan Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
MRS. RAYE NAE NYLANDER (CFO)
(605) 362-3100
Entity
Organization
Contact information
Practice address
23926 4TH AVE S, SIREN, WI 54872-8334
(715) 349-2292
(715) 349-7218
Mailing address
PO 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)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1014259
PREFERRED ONE - THERAPY
WI
01
—
1026758
PREFERRED ONE - INPATIENT
WI
05
—
20158900
—
WI
01
—
7122742
MEDICA
WI
01
—
9840CA
BLUE CROSS BLUE SHIELD
WI
Enumeration date
11/09/2005
Last updated
11/09/2007
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