Healthcare Provider Details

I. General information

NPI: 1104330620
Provider Name (Legal Business Name): RAPID CITY REGIONAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 7TH AVENUE
WALL SD
57790-0010
US

IV. Provider business mailing address

PO BOX 860013
MINNEAPOLIS MN
55486-0013
US

V. Phone/Fax

Practice location:
  • Phone: 605-279-2149
  • Fax: 605-279-2139
Mailing address:
  • Phone: 605-279-2149
  • Fax: 605-279-2139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: RUTA PAULETTE DAVIDSON
Title or Position: COO & PRESIDENT RAPID CITY MARKET
Credential:
Phone: 605-755-9138