NPIMap

Organization Active NPI

The Evangelical Lutheran Good Samaritan Society

  • Assisted Living Facility
  • East Grand Forks, MN
National Provider Identifier
1831170174
Registry record updated Dec 13, 2012
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
2122 River Rd NW
East Grand Forks, MN 56721-1065
Phone
(218) 773-7484
Fax
(218) 773-4287
NPI assigned
Nov 11, 2005
Reactivated
Dec 11, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2012

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

2122 River Rd NW
East Grand Forks, MN 56721-1065

Mailing address

PO Box 5038
Sioux Falls, SD 57117-5038
Phone (605) 362-3100

Other identifiers 1

IdentifierTypeStateIssuer
324819400MedicaidMN

Other names 1

  • Good Samaritan Society - Heritage Grove Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1062859Good Samaritan Heritage Grove2122 River Road NW, East Grand Forks, MN 56721Certificate of waiverDec 27, 2026

National Provider Directory

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

Organizations with this tax ID in the same state 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1131667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355356800000",
    "number": "1831170174",
    "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": "2122 RIVER RD NW",
            "city": "EAST GRAND FORKS",
            "state": "MN",
            "postal_code": "567211065",
            "telephone_number": "218-773-7484",
            "fax_number": "218-773-4287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-11",
        "last_updated": "2012-12-13",
        "deactivation_date": "2008-04-14",
        "reactivation_date": "2012-12-11",
        "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": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "324819400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Samaritan Society - Heritage Grove",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East Grand Forks, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.