Provider Demographics
NPI:1235594722
Name:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY - PIPESTONE
Entity Type:Organization
Organization Name:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY - PIPESTONE
Other - Org Name:RIDGE VIEW ESTATES ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HORAZDOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-825-4885
Mailing Address - Street 1:903 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-1745
Mailing Address - Country:US
Mailing Address - Phone:507-825-4885
Mailing Address - Fax:507-562-1355
Practice Address - Street 1:903 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:PIPESTONE
Practice Address - State:MN
Practice Address - Zip Code:56164-1745
Practice Address - Country:US
Practice Address - Phone:507-825-4885
Practice Address - Fax:507-562-1355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN375384310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility