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Contact Information

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
3815 W BROADWAY
ROBBINSDALE, MN55422-2207
 Phone: 612-332-4262
 Fax: 612-673-6270
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Facility Supplies

332BN1400X 87 All Other Suppliers
 

Parenteral & Enteral Nutrition

332BP3500X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

NPI Number 1659361061
LBN Legal business name THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official ERIC VANDENHULL - (CFO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 10/26/2005
Last updated 11/26/2021 - About 5 years ago
Identifiers
MN Medicaid 138218700
MN Other 5A26UN BLUE CROSS BLUE SHIELD
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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