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General NPI Number Information
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NPI Number | 1447400700
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Entity Type | Organization
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Legal Business Name | SILVER THREADS, INC.
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Dates
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Enumeration Date | 09/23/2008
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Last Update Date | 09/23/2008
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Provider Practice Location Address
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Address Line | 210 E 12TH ST
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City | GREGORY
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State | SD
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Zip | 57533-1181
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Country | US
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Telephone | 605-832-9717
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Fax |
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Provider Business Mailing Address
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Address Line | 210 E 12TH ST
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City | GREGORY
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State | SD
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Zip | 57533-1181
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Country | US
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Telephone | 605-832-9717
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JACK GUNVORDAHL
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Credential |
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Telephone | 605-775-2531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | APPLIED FOR
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License Number State | SD
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