1568835452 NPI number — ESTELLINE NURSING AND CARE CENTER

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 1568835452 NPI number — ESTELLINE NURSING AND CARE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESTELLINE NURSING AND CARE CENTER
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:
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:
1568835452
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 E FJERESTAD AVE
Provider Second Line Business Mailing Address:
PO BOX 130
Provider Business Mailing Address City Name:
ESTELLINE
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57234-0130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-873-2278
Provider Business Mailing Address Fax Number:
605-873-2989

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E FJERESTAD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ESTELLINE
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57234-0130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-873-2278
Provider Business Practice Location Address Fax Number:
605-873-2989
Provider Enumeration Date:
11/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
605-873-2278

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com