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General NPI Number Information
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NPI Number | 1699759001
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Entity Type | Organization
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Legal Business Name | ELLEN STEPHEN HOSPICE AND HOMECARE
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Dates
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Enumeration Date | 11/30/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1 MAIN
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City | KYLE
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State | SD
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Zip | 57752
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Country | US
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Telephone | 605-455-1217
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Fax | 605-455-1218
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Provider Business Mailing Address
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Address Line | PO BOX 488
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City | KYLE
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State | SD
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Zip | 57752-0488
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Country | US
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Telephone | 605-455-1217
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Fax | 605-455-1218
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Authorized Official
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Title or Position | DIRECTOR/RN
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Name | MR. BRUCE ALAN WILLIAMS
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Credential | RN
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Telephone | 605-455-1217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number |
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License Number State | SD
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