The Evangelical Lutheran Good Samaritan Society
Organization Active NPI Skilled Nursing Facility · Clearbrook, MN
NPI 1447241815 · NPPES record last updated Dec 27, 2012
Key facts
- NPI
- 1447241815
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
- Practice address
- 305 3Rd Ave SW
Clearbrook, MN 56634-9803 - Phone
- (218) 776-3157
- Fax
- (218) 776-3836
- NPI assigned
- Nov 3, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
- Name
- Mrs. Raye Nae Nylander
- Title
- Cfo
- Phone
- (605) 362-3100
Member of 1
National Provider Directory
- Part of
- Red Oak Iowa Good Sam C
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes | ||
| Nursing Facility Supplies (DME) | 332BN1400X | |||
| Parenteral & Enteral Nutrition Supplies (DME) | 332BP3500X |
Addresses
Primary practice location
305 3Rd Ave SW
Clearbrook, MN 56634-9803
Mailing address
PO Box 5038
Sioux Falls, SD 57117-5038
Phone (605) 362-3100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017740700 | Medicaid | MN | |
| 2C98CL | Other | MN | BLUE CROSS BLUE SHIELD |
| 30375 | Medicaid | MN |
Other names
- Good Samaritan Society - Clearbrook
Other providers in Clearbrook, MN
- Roberta Otting
- Alicia Pataky
- Sanford Health of Northern Minnesota
- Matthew Brian Singh
- Stellher Human Services, Inc.
- Patricia Thorssen
All providers in Clearbrook, MN · Skilled Nursing Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 27, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.