Healthcare Provider Details

I. General information

NPI: 1104084466
Provider Name (Legal Business Name): LEISURE LIVING II, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 5TH ST
HARTFORD SD
57033-2275
US

IV. Provider business mailing address

27 ARROWHEAD PASS
MITCHELL SD
57301-5073
US

V. Phone/Fax

Practice location:
  • Phone: 605-528-7406
  • Fax:
Mailing address:
  • Phone: 605-770-2500
  • Fax: 605-292-0228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number41964
License Number StateSD

VIII. Authorized Official

Name: TERRY SABERS
Title or Position: TREASURER
Credential:
Phone: 605-770-2500