MEDICARE: KISMET ELK 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
1	385H00000X	Respite Care
2	314000000X	Skilled Nursing Facility	10615	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	:	1821099102
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KISMET ELK LLC

Provider Business Mailing Address
First Line	:	PO BOX 486
Second Line	:	600 S. FRANKLIN
City	:	ELK POINT
State	:	SD
Zip	:	57025-0486
Country	:	US
Telephone Number	:	605-356-2622
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 SOUTH FRANKLIN ST
Second Line	:
City	:	ELK POINT
State	:	SD
Zip	:	57025-0486
Country	:	US
Telephone Number	:	605-356-2622
Fax Number	:

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MICHAEL L. MOORE
Credential	:
Telephone Number	:	605-642-7736

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/29/2020

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Directions to “KISMET ELK LLC ” Practice Location

Language	Start Address	Practice Location

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