Healthcare Provider Details

I. General information

NPI: 1801573969
Provider Name (Legal Business Name): REHABILITATION AND CRITICAL CARE HOSPITAL OF THE BLACK HILLS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/30/2023
Certification Date: 06/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 PROMISE ROAD
RAPID CITY SD
57701-8981
US

IV. Provider business mailing address

4600 LENA DR
MECHANICSBURG PA
17055-4904
US

V. Phone/Fax

Practice location:
  • Phone: 605-646-6040
  • Fax: 605-646-6450
Mailing address:
  • Phone: 559-892-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL LONG
Title or Position: PRESIDENT
Credential:
Phone: 856-745-6533