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

Robbinsdale Good Samaritan Center

Practice address

3815 W Broadway Ave
Robbinsdale, MN 55422-2207

Phone

(763) 588-4635

Fax

(763) 588-9405

NPI assigned

Oct 26, 2005

Reactivated

Jul 19, 2007

Organization subpart

No

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

Addresses

Other identifiers 5

Other names 1

• Robbinsdale Good Samaritan Center Doing business as

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

{
    "created_epoch": "1130284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184803200000",
    "number": "1811987381",
    "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": "3815 W BROADWAY AVE",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222207",
            "telephone_number": "763-588-4635",
            "fax_number": "763-588-9405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-26",
        "last_updated": "2007-07-19",
        "deactivation_date": "2006-10-25",
        "reactivation_date": "2007-07-19",
        "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": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "7110090",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE (MEDICA)",
            "identifier": "7111785",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": "ASSISTED LIVING",
            "identifier": "5A13CR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE OF MN",
            "identifier": "NH0014",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1026653",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Robbinsdale Good Samaritan Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alexis Tebben, RD, LD
• Daryl Ray Tharp Jr., MD
• The Dental Suite PLLC
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Society - Home Care)
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Society - Specialty Care Community)
• The Evangelical Lutheran Good Samaritan Society (Good Samaritan Society- Home Care)
• Christopher Nicholas Thein, MS, ATC, EMT
• Thomas M Dewerd DDS PA
• Merrill Thomas, M.D.
• Patina Thomas, LPCC, LADC

• Skilled Nursing Facility in Robbinsdale, MN
• Providers in Robbinsdale, 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 Jul 19, 2007; 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.