Healthcare Provider Details

I. General information

NPI: 1366471666
Provider Name (Legal Business Name): WOODROW WILSON KEEBLE MEMORIAL HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 LAKE TRAVERSE DRIVE
SISSETON SD
57262
US

IV. Provider business mailing address

100 LAKE TRAVERSE DRIVE
SISSETON SD
57262
US

V. Phone/Fax

Practice location:
  • Phone: 605-698-7606
  • Fax: 605-742-3882
Mailing address:
  • Phone: 605-698-7606
  • Fax: 605-742-3882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. JUANITA GOTT
Title or Position: CEO
Credential:
Phone: 605-698-7606