Healthcare Provider Details

I. General information

NPI: 1518909308
Provider Name (Legal Business Name): BRYANT PARKVIEW CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 6TH AVE W
BRYANT SD
57221-2012
US

IV. Provider business mailing address

PO BOX 247
BRYANT SD
57221-0247
US

V. Phone/Fax

Practice location:
  • Phone: 605-628-2771
  • Fax: 605-628-2773
Mailing address:
  • Phone: 605-628-2771
  • Fax: 605-628-2773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10602
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0160280
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

Name: LYNALLE KAY RUST
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-628-2771