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Organization

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Active
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other names
Good Samaritan Society - Lodi
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
700 CLARK ST, LODI, WI 53555-1010
(608) 592-3241
(608) 592-3293
Mailing address
4800 WEST 57TH STREET P.O. 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
20150000
WI
01
553711
DEAN HEALTH PLAN
WI
Enumeration date
12/06/2005
Last updated
07/31/2014
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