GOOD SAMARITAN SOCIETY - SCANDIA VILLAGE
NPI 1528049301
Skilled Nursing Facility in Sister Bay, WI

Active since November 09, 2005CLIA 52D0394778 · Waiver
10560 APPLEWOOD DR, SISTER BAY, WI 54234(920) 854-2317(920) 854-9529 Get Directions Write a Review

NPPES record last updated: November 28, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Good Samaritan Society - Scandia Village NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GOOD SAMARITAN SOCIETY - SCANDIA VILLAGE (NPI 1528049301) is a healthcare organization registered as a skilled nursing facility in Sister Bay, Wisconsin and active in the NPI registry since November 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Raye Nae Nylander, Cfo, as its authorized official.

NPPES Registry Identity

NPI1528049301
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameTHE EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Location Address10560 APPLEWOOD DRSister Bay, WI 54234-9005
Mailing AddressPo Box 5038Sioux Falls, SD 57117-5038 · (605) 362-3100 · Fax (605) 362-3265
Fax(920) 854-9529
Organization SubpartYes
Authorized OfficialRaye Nae NylanderCfo · (605) 362-3100
Enumeration DateNovember 9, 2005
Last NPPES UpdateNovember 28, 2021
NPPES CertifiedNovember 28, 2021
NPI 1528049301 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
10560 APPLEWOOD DR, Sister Bay, WI 54234

Other Names 1

Doing Business AsGood Samaritan Society - Scandia Village

Other Identifiers 1

Medicaid20172400WI

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0394778

Good Samaritan Society-Scandia Village · Sister Bay, WI
Active · expires Aug 31, 2026
CLIA Number52D0394778
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorDr. Rory M. Johnson
Laboratory Phone(920) 854-2317
Laboratory LocationGood Samaritan Society-Scandia Village10560 Applewood Rd, Sister Bay, WI 54234
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Physical Therapy Assistant
10560 APPLEWOOD DR
SISTER BAY, WI 54234

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is The Evangelical Lutheran Good Samaritan Society's NPI number?

The NPI number for The Evangelical Lutheran Good Samaritan Society is 1528049301. It was assigned to this organization in the NPPES registry on November 9, 2005. The provider is doing business as Good Samaritan Society - Scandia Village.

Where is The Evangelical Lutheran Good Samaritan Society located?

The Evangelical Lutheran Good Samaritan Society is located at 10560 Applewood Dr, Sister Bay, WI 54234. The listed phone number is (920) 854-2317.

What is The Evangelical Lutheran Good Samaritan Society's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does The Evangelical Lutheran Good Samaritan Society hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D0394778) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does The Evangelical Lutheran Good Samaritan Society accept?

Health plans from HealthPartners list The Evangelical Lutheran Good Samaritan Society as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for The Evangelical Lutheran Good Samaritan Society was last updated on November 28, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.