Provider Demographics
NPI:1790373686
Name:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity Type:Organization
Organization Name:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDEN HULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-5510
Mailing Address - Street 1:2304 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:TYNDALL
Mailing Address - State:SD
Mailing Address - Zip Code:57066-2214
Mailing Address - Country:US
Mailing Address - Phone:605-589-3350
Mailing Address - Fax:605-589-3686
Practice Address - Street 1:2304 LAUREL ST
Practice Address - Street 2:
Practice Address - City:TYNDALL
Practice Address - State:SD
Practice Address - Zip Code:57066-2214
Practice Address - Country:US
Practice Address - Phone:605-589-3350
Practice Address - Fax:605-589-3686
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility