Provider Demographics
NPI:1568444933
Name:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type:Organization
Organization Name:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other - Org Name:GOOD SAMARITAN SOCIETY - NORTHWEST KANSAS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:RAYE NAE
Authorized Official - Middle Name:
Authorized Official - Last Name:NYLANDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-3100
Mailing Address - Street 1:PO BOX 5038
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5038
Mailing Address - Country:US
Mailing Address - Phone:605-362-3100
Mailing Address - Fax:605-362-3265
Practice Address - Street 1:217 EAST HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:ST FRANCIS
Practice Address - State:KS
Practice Address - Zip Code:67756-5934
Practice Address - Country:US
Practice Address - Phone:785-332-3588
Practice Address - Fax:785-332-3594
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-18
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1164OtherNORTHWEST KS AREA AGENCY
KS7610OtherTRAVELERS WORKMANS COMP
KS1521OtherBLUE CROSS BLUE SHIELD
KS100065560AMedicaid
KS111OtherAMERICAN CARE SOURCE
KS4972OtherBERKLEY RISK ADMINISTRATO
KS2709OtherANTHEM BLUE CROSS
KS4972OtherBERKLEY RISK ADMINISTRATO