Healthcare Provider Details

I. General information

NPI: 1699759001
Provider Name (Legal Business Name): ELLEN STEPHEN HOSPICE AND HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MAIN
KYLE SD
57752
US

IV. Provider business mailing address

PO BOX 488
KYLE SD
57752-0488
US

V. Phone/Fax

Practice location:
  • Phone: 605-455-1217
  • Fax: 605-455-1218
Mailing address:
  • Phone: 605-455-1217
  • Fax: 605-455-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number StateSD

VIII. Authorized Official

Name: MR. BRUCE ALAN WILLIAMS
Title or Position: DIRECTOR/RN
Credential: RN
Phone: 605-455-1217