Healthcare Provider Details

I. General information

NPI: 1538231048
Provider Name (Legal Business Name): ROSHOLT NURSING INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 FIRST AVENUE EAST
ROSHOLT SD
57260-0108
US

IV. Provider business mailing address

85 1ST AVENUE EAST
ROSHOLT SD
57260-0108
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 Number10672
License Number StateSD

VIII. Authorized Official

Name: MS. TINA MULLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 605-537-4272