MEDICARE: JUDY'S ASSISTED LIVING

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
1	310400000X	Assisted Living Facility	10731	SD

General Provider Information

NPI Number	:	1326206046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUDY'S ASSISTED LIVING

Provider Business Mailing Address
First Line	:	1308 SUNDANCE CIR
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-1630
Country	:	US
Telephone Number	:	605-723-4792
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 SUNDANCE CIR
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-1630
Country	:	US
Telephone Number	:	605-723-4792
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	JUDY RIEDEL
Credential	:
Telephone Number	:	605-723-4792

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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