Healthcare Provider Details

I. General information

NPI: 1730238973
Provider Name (Legal Business Name): EASTERN STAR HOME OF SOUTH DAKOTA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 W 12TH AVE
REDFIELD SD
57469-1522
US

IV. Provider business mailing address

PO BOX 150
REDFIELD SD
57469-0150
US

V. Phone/Fax

Practice location:
  • Phone: 605-472-0658
  • Fax: 605-472-3590
Mailing address:
  • Phone: 605-472-0658
  • Fax: 605-472-3590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number10670
License Number StateSD

VIII. Authorized Official

Name: MARY A RICE
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-472-0658