Provider Demographics
NPI:1740261742
Name:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity type:Organization
Organization Name:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP, FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-5416
Mailing Address - Street 1:4800 W 57TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2239
Mailing Address - Country:US
Mailing Address - Phone:605-323-3453
Mailing Address - Fax:
Practice Address - Street 1:3901 MONTECITO DR
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-5557
Practice Address - Country:US
Practice Address - Phone:940-891-0856
Practice Address - Fax:940-891-2662
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-08
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH2928OtherBLUE CROSS BLUE SHIELD
TX0140910096Medicare NSC
SD455685Medicare Oscar/Certification
TXHH2928OtherBLUE CROSS BLUE SHIELD