Healthcare Provider Details

I. General information

NPI: 1366457061
Provider Name (Legal Business Name): BORDER REHAB, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 1ST AVENUE EAST
ROSHOLT SD
57260-0108
US

IV. Provider business mailing address

2231 60TH AVE S
FARGO ND
58104-7602
US

V. Phone/Fax

Practice location:
  • Phone: 605-537-4272
  • Fax: 605-537-4385
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberSD#1176
License Number StateSD

VIII. Authorized Official

Name: MATTHEW GARY ASKIM
Title or Position: PRESIDENT
Credential:
Phone: 701-235-1393