Organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - Lake Forest Village
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
MR. JOEL FLUIT (VP, FINANCE)
(605) 362-5416
Entity
Organization
Contact information
Practice address
3901 MONTECITO DR, DENTON, TX 76210-5557
(940) 891-0856
(940) 891-2662
Mailing address
4800 W 57TH ST, SIOUX FALLS, SD 57108-2239
(605) 323-3453
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
—
HH2928
BLUE CROSS BLUE SHIELD
TX
Enumeration date
11/08/2005
Last updated
07/19/2023
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