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NPI Code Detail

MEDICARE: RAPID CITY HEALTHCARE, LLC

MEDICARE: RAPID CITY 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 Facility10723SD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750386660
Entity Type Code : Organization
Provider Name (Legal Business Name) : RAPID CITY HEALTHCARE, LLC
Provider Business Mailing 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 : 605-348-1979
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 : 605-348-1979
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. THOMAS E. BOERBOOM
Credential :
Telephone Number : 952-873-7907
Provider Enumeration Date : 06/16/2005
Last Update Date : 02/09/2011

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Directions to “RAPID CITY HEALTHCARE, LLC ” Practice Location

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