Organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - Roseville
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
1415 COUNTY ROAD B W, ROSEVILLE, MN 55113-4216
(651) 631-1616
(651) 631-1899
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)
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030443
—
MN
01
—
1026654
PREFERRED ONE INPATIENT
MN
01
—
1026655
PREFERRED ONE
MN
01
—
5A23GO
BLUE CROSS BLUE SHIELD
MN
01
—
5A23GO9
COMPREHENSIVE CARE
MN
01
—
7100093
PMAP EVERCARE
MN
01
—
7111788
MEDICA
MN
05
—
82516300
—
MN
01
—
NH0088
UCARE
MN
Enumeration date
11/16/2005
Last updated
11/07/2007
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