MEDICARE: ELLEN STEPHEN HOSPICE AND HOMECARE

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	163WH0200X	Home Health Registered Nurse		SD

Other Identifiers

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

General Provider Information

NPI Number	:	1699759001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN STEPHEN HOSPICE AND HOMECARE

Provider Business Mailing Address
First Line	:	PO BOX 488
Second Line	:
City	:	KYLE
State	:	SD
Zip	:	57752-0488
Country	:	US
Telephone Number	:	605-455-1217
Fax Number	:	605-455-1218

Provider Business Practice Location Address
First Line	:	1 MAIN
Second Line	:
City	:	KYLE
State	:	SD
Zip	:	57752
Country	:	US
Telephone Number	:	605-455-1217
Fax Number	:	605-455-1218

Authorized Official
Title or Position	:	DIRECTOR/RN
Name	:	MR. BRUCE ALAN WILLIAMS
Credential	:	RN
Telephone Number	:	605-455-1217

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/21/2022

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Directions to “ELLEN STEPHEN HOSPICE AND HOMECARE ” Practice Location

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