Healthcare Provider Details

I. General information

NPI: 1326020108
Provider Name (Legal Business Name): KISMET ELK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E LINCOLN ST
ELK POINT SD
57025-2284
US

IV. Provider business mailing address

600 E LINCOLN ST
ELK POINT SD
57025-2284
US

V. Phone/Fax

Practice location:
  • Phone: 605-356-3894
  • Fax:
Mailing address:
  • Phone: 605-356-3894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL L. MOORE
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 605-642-7736