The Evangelical Lutheran Good Samaritan Society

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY

Doing business as

Good Samaritan Society - Warren

Practice address

410 S McKinley St
Warren, MN 56762-1433

Phone

(218) 745-5282

Fax

(218) 745-6434

NPI assigned

Oct 26, 2005

Last updated

Dec 28, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETYAs reported in NPPES

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

Authorized official

Name

Ms. Raye Nae Nylander

Title

Cfo

Phone

(605) 362-3100

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• Good Samaritan Society - Warren Doing business as

Part of

Good Samaritan Home

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• The Evangelical Lutheran Good Samaritan Society

  dba Good Samaritan - Ottumwa

  • Skilled Nursing Facility
  • Ottumwa, IA
  • NPI 1235129735

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356652800000",
    "number": "1457341885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5038",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175038",
            "telephone_number": "605-362-3100",
            "fax_number": "605-362-3265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S MCKINLEY ST",
            "city": "WARREN",
            "state": "MN",
            "postal_code": "567621433",
            "telephone_number": "218-745-5282",
            "fax_number": "218-745-6434"
        }
    ],
    "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": "2005-10-26",
        "last_updated": "2012-12-28",
        "status": "A",
        "authorized_official_last_name": "NYLANDER",
        "authorized_official_first_name": "RAYE NAE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "605-362-3100",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "304842000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "NH0432",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "7100219",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "9717WA",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Samaritan Society - Warren",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark Alan Pederson, DC
• Paige Pederson
• Shane Skeim, FNP-C
• Jill J Smith, NP-C
• Nicole Rose Steien
• Warren Community Hospital, Inc. (North Valley Health Center)
• Warren Community Hospital, Inc. (North Valley Public Health)
• Warren Community Hospital, Inc. (North Valley Health Center)
• Warren Economic Development Authority (North Star Assisted Living)
• Warren Eye Care, P.C.

• Skilled Nursing Facility in Warren, MN
• Providers in Warren, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2012; 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.