Healthcare Provider Details

I. General information

NPI: 1851373138
Provider Name (Legal Business Name): UNITED RETIREMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 1ST AVE UNITED LIVING COMMUNITY
BROOKINGS SD
57006-1835
US

IV. Provider business mailing address

405 1ST AVE UNITED LIVING COMMUNITY
BROOKINGS SD
57006-1835
US

V. Phone/Fax

Practice location:
  • Phone: 605-692-5351
  • Fax: 605-692-3556
Mailing address:
  • Phone: 605-692-5351
  • Fax: 605-692-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0160050
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10601
License Number StateSD

VIII. Authorized Official

Name: JOSHUA JOHNSON
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 567-344-0346