Organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - Daytona
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
MR. ERIC VANDEN HULL (VP, FINANCE)
(605) 362-3100
Entity
Organization
Contact information
Practice address
325 S SEGRAVE ST, DAYTONA BEACH, FL 32114-4220
(386) 253-6791
(386) 258-3842
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
—
020439100
—
FL
01
—
141221300
MEDICAID ALF OSS
FL
05
—
675714601
—
FL
01
—
7100409
EVERCARE
FL
01
—
K2S
BLUE CROSS BLUE SHIELD
FL
Enumeration date
11/15/2005
Last updated
10/25/2021
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