Healthcare Provider Details

I. General information

NPI: 1740695675
Provider Name (Legal Business Name): NORTHEAST CARE AND REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 06/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 S 1ST AVE
ROSHOLT SD
57260
US

IV. Provider business mailing address

85 S 1ST AVE PO BOX 108
ROSHOLT SD
57260
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

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