Healthcare Provider Details

I. General information

NPI: 1235223942
Provider Name (Legal Business Name): SALEM MENNONITE HOME FOR THE AGED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 W. 7TH STREET
FREEMAN SD
57029-2319
US

IV. Provider business mailing address

106 W. 7TH STREET
FREEMAN SD
57029-2319
US

V. Phone/Fax

Practice location:
  • Phone: 605-925-4994
  • Fax: 605-925-4764
Mailing address:
  • Phone: 605-925-4994
  • Fax: 605-925-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number10622
License Number StateSD

VIII. Authorized Official

Name: STEWART HOFER
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-925-4994