Organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - University Specialty Center, Good Samaritan Society - Specialty Care Community
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
MS. ERIC VANDENHULL (CFO)
(605) 362-3100
Entity
Organization
Contact information
Practice address
3815 W BROADWAY, ROBBINSDALE, MN 55422-2207
(612) 332-4262
(612) 673-6270
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
—
138218700
—
MN
01
—
5A26UN
BLUE CROSS BLUE SHIELD
MN
Enumeration date
10/26/2005
Last updated
11/26/2021
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