Provider Demographics
NPI:1932181310
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:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VANDENHULL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-362-3100
Mailing Address - Street 1:2885 COUNTRY DR STE 165
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-1097
Mailing Address - Country:US
Mailing Address - Phone:651-488-7680
Mailing Address - Fax:651-488-7687
Practice Address - Street 1:2885 COUNTRY DR STE 165
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55117-1097
Practice Address - Country:US
Practice Address - Phone:651-488-7680
Practice Address - Fax:651-488-7687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE 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
MN1026762OtherPREFERRED ONE
MN129667OtherUCARE
MN4980077OtherMEDICA
MN9K40G0OtherINSURANCE BLUE PLUS
MN612216700Medicaid
MN129667OtherUCARE