Organization Name:  THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY


Practice Location:
320 PUEBLO AVENUE  SIMLA, CO 80835 US
Tel: 719-541-2269  Fax: --

Business Mailing Address:
  ,   
Tel: --  Fax: --


Taxonomy:

Primary	Code	Category/Description	State	License Number
N	314000000X	Nursing & Custodial Care Facilities Skilled Nursing Facility
N	332BN1400X	Suppliers Durable Medical Equipment & Medical Supplies
N	332BP3500X	Suppliers Durable Medical Equipment & Medical Supplies
Y	313M00000X	Nursing & Custodial Care Facilities Nursing Facility/Intermediate Care Facility

Other Provider Identifiers:

Issuer	Number	State	Type
COLORADO RESPITE	85175218	CO	01
	05653506	CO	05

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin