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General NPI Number Information
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NPI Number | 1518370907
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Entity Type | Organization
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Legal Business Name | ROSE MANOR
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 317 MAIN ST
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City | COLOME
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State | SD
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Zip | 57528-2101
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Country | US
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Telephone | 605-842-1066
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Fax |
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Provider Business Mailing Address
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Address Line | 317 MAIN ST
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City | COLOME
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State | SD
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Zip | 57528-2101
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Country | US
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Telephone | 605-842-1066
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Fax |
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Authorized Official
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Title or Position | CO-OWNER
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Name | PHYLLIS MEINERS
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Credential |
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Telephone | 605-840-1247
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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 | 51814
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License Number State | SD
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