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NPI Code Detail

MEDICARE: BELLE FOURCHE HEALTHCARE, LLC

MEDICARE: BELLE FOURCHE HEALTHCARE, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility10594SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063475812
Entity Type Code : Organization
Provider Name (Legal Business Name) : BELLE FOURCHE HEALTHCARE, LLC
Provider Business Mailing Address
First Line : 2200 - 13TH AVENUE
Second Line :
City : BELLE FOURCHE
State : SD
Zip : 57717-2215
Country : US
Telephone Number : 605-892-3331
Fax Number : 605-723-0204
Provider Business Practice Location Address
First Line : 2200 - 13TH AVENUE
Second Line :
City : BELLE FOURCHE
State : SD
Zip : 57717-2215
Country : US
Telephone Number : 605-892-3331
Fax Number : 605-723-0204
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. THOMAS E. BOERBOOM
Credential :
Telephone Number : 952-873-7907
Provider Enumeration Date : 04/11/2006
Last Update Date : 11/03/2014

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Directions to “BELLE FOURCHE HEALTHCARE, LLC ” Practice Location

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