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NPI Code Detail

MEDICARE: EMPRES AT RAPID CITY, LLC

MEDICARE: EMPRES AT RAPID CITY, 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 Facility

General Provider Information

NPI Number : 1558833426
Entity Type Code : Organization
Provider Name (Legal Business Name) : EMPRES AT RAPID CITY, LLC
Provider Business Mailing Address
First Line : 4601 NE 77TH AVE STE 300
Second Line :
City : VANCOUVER
State : WA
Zip : 98662-6736
Country : US
Telephone Number : 360-892-6628
Fax Number : 360-882-5793
Provider Business Practice Location Address
First Line : 2000 WESLEYAN BLVD
Second Line :
City : RAPID CITY
State : SD
Zip : 57702-9340
Country : US
Telephone Number : 605-343-3555
Fax Number : 605-721-1457
Authorized Official
Title or Position : CFO AND ASSISTANT MANAGER
Name : MICHAEL J. MILLER
Credential :
Telephone Number : 360-892-6628
Provider Enumeration Date : 12/17/2018
Last Update Date : 12/17/2018

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