Healthcare Provider Details

I. General information

NPI: 1205730314
Provider Name (Legal Business Name): ESL SD VICTORIAN OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 COLUMBUS ST
RAPID CITY SD
57701-2538
US

IV. Provider business mailing address

1321 COLUMBUS ST
RAPID CITY SD
57701-2538
US

V. Phone/Fax

Practice location:
  • Phone: 605-791-1866
  • Fax:
Mailing address:
  • Phone: 605-791-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANGELA WIEDERICH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 605-340-6400