NPIMap

Organization Active NPI

The Evangelical Lutheran Good Samaritan Society

  • Assisted Living Facility
  • Moscow, ID
National Provider Identifier
1154545242
Registry record updated Jun 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Practice address
640 N Eisenhower St
Moscow, ID 83843-9588
Phone
(208) 882-6560
Fax
(208) 882-6569
NPI assigned
Apr 12, 2007
Organization subpart
Yes
Parent organization
THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Raye Nae Nylander
Title
Vice President, Cfo
Phone
(605) 362-3100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

640 N Eisenhower St
Moscow, ID 83843-9588

Mailing address

4800 W 57TH St
Sioux Falls, SD 57108-2239
Phone (605) 362-3100

Other identifiers 1

IdentifierTypeStateIssuer
8063117MedicaidID

Other names 1

  • Good Samaritan Society Moscow Village Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Red Oak Iowa Good Sam C210 organizations share this tax ID, including this one
Part of
Red Oak Iowa Good Sam C

Organizations with this tax ID in the same state 3

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654732800000",
    "number": "1154545242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 W 57TH ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571082239",
            "telephone_number": "605-362-3100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 N EISENHOWER ST",
            "city": "MOSCOW",
            "state": "ID",
            "postal_code": "838439588",
            "telephone_number": "208-882-6560",
            "fax_number": "208-882-6569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY",
        "enumeration_date": "2007-04-12",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A",
        "authorized_official_last_name": "NYLANDER",
        "authorized_official_first_name": "RAYE NAE",
        "authorized_official_title_or_position": "VICE PRESIDENT, CFO",
        "authorized_official_telephone_number": "605-362-3100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8063117",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Samaritan Society Moscow Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moscow, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.