MEDICARE: ELK POINT HEALTHCARE #2, 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	310400000X	Assisted Living Facility	41022	SD

General Provider Information

NPI Number	:	1952648172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELK POINT HEALTHCARE #2, LLC

Provider Business Mailing Address
First Line	:	600 E LINCOLN ST
Second Line	:
City	:	ELK POINT
State	:	SD
Zip	:	57025-2284
Country	:	US
Telephone Number	:	605-356-2774
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 E LINCOLN ST
Second Line	:
City	:	ELK POINT
State	:	SD
Zip	:	57025-2284
Country	:	US
Telephone Number	:	605-356-2774
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. BRADLEY MOLGARD
Credential	:
Telephone Number	:	952-873-7977

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/08/2013

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