MEDICARE: STATE HOME CARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	0000	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487659736
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STATE HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	1301 W OMAHA ST STE 208
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2603
Country	:	US
Telephone Number	:	605-718-5004
Fax Number	:	605-718-5006

Provider Business Practice Location Address
First Line	:	1301 W OMAHA ST STE 208
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-2603
Country	:	US
Telephone Number	:	605-718-5004
Fax Number	:	605-718-5006

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ANDREW PATRICK BEEDLE
Credential	:	RN
Telephone Number	:	605-718-5004

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	09/14/2021

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Directions to “STATE HOME CARE SERVICES, INC. ” Practice Location

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