1043228810 NPI number — FALL RIVER HEALTH SERVICES

Table of content: (NPI 1043228810)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043228810 NPI number — FALL RIVER HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FALL RIVER HEALTH SERVICES
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:
Provider Other Organization Name Type Code:
6
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:
1043228810
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 HIGHWAY 71 SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57747-1374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-745-3159
Provider Business Mailing Address Fax Number:
605-745-3957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 HIGHWAY 71 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57747-1374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-745-3159
Provider Business Practice Location Address Fax Number:
605-745-3957
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
B
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
605-745-3159

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5340260 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83423 . This is a "WELLMARK" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com