Organization Name:  THE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY


Practice Location:
705 4TH ST SE  CROSBY, ND 58730 US
Tel: 701-965-6086  Fax: --

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


Taxonomy:

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

Other Provider Identifiers:

Issuer	Number	State	Type
BLUE CROSS BLUE SHIELD	8185	ND	01
	30122	ND	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