1851361828 NPI number — PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851361828 NPI number — PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WESTHILLS VILLAGE HEALTHCARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851361828
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
255 TEXAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RAPID CITY
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57701-7362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-342-0255
Provider Business Mailing Address Fax Number:
605-394-3605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
255 TEXAS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RAPID CITY
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57701-7362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-342-0255
Provider Business Practice Location Address Fax Number:
605-394-3605
Provider Enumeration Date:
01/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REINICKE
Authorized Official First Name:
DARYL
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
605-342-0255

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  10721 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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