Healthcare Provider Details

I. General information

NPI: 1083693584
Provider Name (Legal Business Name): TIESZEN MEMORIAL HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 E STATE ST
MARION SD
57043-2011
US

IV. Provider business mailing address

312 E STATE ST
MARION SD
57043-2011
US

V. Phone/Fax

Practice location:
  • Phone: 605-648-3611
  • Fax: 605-648-3363
Mailing address:
  • Phone: 605-648-3611
  • Fax: 605-648-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number41974
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10647
License Number StateSD

VIII. Authorized Official

Name: MR. PAUL I ENGBRECHT
Title or Position: CEO
Credential:
Phone: 605-648-3611