Provider Demographics
NPI:1144414954
Name:EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Entity type:Organization
Organization Name:EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:TANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-669-3100
Mailing Address - Street 1:2101 S GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-7377
Mailing Address - Country:US
Mailing Address - Phone:970-669-3100
Mailing Address - Fax:970-663-4526
Practice Address - Street 1:2101 S GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-7377
Practice Address - Country:US
Practice Address - Phone:970-669-3100
Practice Address - Fax:970-663-4526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC374108OtherMEDIARE ID NUMBER