NPIMap

Organization Active NPI

The Evangelical Lutheran Good Samaritan Society

  • Assisted Living Facility
  • Superior, NE
National Provider Identifier
1902948482
Registry record updated Aug 22, 2020
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
1160 Sunrise St
Superior, NE 68978-2344
Phone
(402) 879-3099
Fax
(402) 879-3445
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

1160 Sunrise St
Superior, NE 68978-2344

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
10025321600MedicaidNE

Other names 1

  • Victorian Legacy 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
28D2003584GSS Superior Victorian Legacy1160 Sunrise St, Superior, NE 68978Certificate of waiverFeb 11, 2028

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 15

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

View all 15

Locations

1160 Sunrise St
Superior, NE 68978
Phone (402) 879-3099

NPI Registry JSON

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

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902948482",
    "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": "1160 SUNRISE ST",
            "city": "SUPERIOR",
            "state": "NE",
            "postal_code": "689782344",
            "telephone_number": "402-879-3099",
            "fax_number": "402-879-3445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2020-08-22",
        "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": "10025321600",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victorian Legacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Superior, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.