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General NPI Number Information
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NPI Number | 1336130004
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Entity Type | Organization
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Legal Business Name | TEKAKWITHA NURSING CENTER INC
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 6 E CHESTNUT ST
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City | SISSETON
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State | SD
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Zip | 57262-1449
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Country | US
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Telephone | 605-698-7693
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Fax | 605-698-3091
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Provider Business Mailing Address
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Address Line | 6 E CHESTNUT ST
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City | SISSETON
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State | SD
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Zip | 57262-1449
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Country | US
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Telephone | 605-698-7693
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Fax | 605-698-3091
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Authorized Official
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Title or Position | ADMINISTRATOR/CEO
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Name | MR. JAMES PETER CORNELIUS
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Credential |
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Telephone | 605-698-7693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 10685
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License Number State | SD
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