Healthcare Provider Details

I. General information

NPI: 1417039504
Provider Name (Legal Business Name): CITY OF BROOKINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 12/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 22ND AVE
BROOKINGS SD
57006-2480
US

IV. Provider business mailing address

300 22ND AVE
BROOKINGS SD
57006-2480
US

V. Phone/Fax

Practice location:
  • Phone: 605-696-9000
  • Fax: 605-696-7728
Mailing address:
  • Phone: 605-696-9000
  • Fax: 605-696-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10600
License Number StateSD

VIII. Authorized Official

Name: MRS. MELISSA WAGNER
Title or Position: CFO
Credential:
Phone: 605-696-9000