MEDICARE: AMERICAN BAPTIST HOMES OF THE MIDWEST

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	310400000X	Assisted Living Facility	10744	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	:	1497743603
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMERICAN BAPTIST HOMES OF THE MIDWEST

Provider Business Mailing Address
First Line	:	3408 W RALPH ROGERS RD
Second Line	:	SUITE 100
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2602
Country	:	US
Telephone Number	:	605-339-9123
Fax Number	:	605-339-0080

Provider Business Practice Location Address
First Line	:	3408 W RALPH ROGERS RD
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57108-2602
Country	:	US
Telephone Number	:	605-339-9123
Fax Number	:	605-373-2602

Authorized Official
Title or Position	:	DIRECTOR OF RESIDENT RECEIVABLES
Name	:	CHRISTINA R KOTZ
Credential	:
Telephone Number	:	402-639-3008

Provider Enumeration Date	:	10/11/2005
Last Update Date	:	05/23/2019

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Directions to “AMERICAN BAPTIST HOMES OF THE MIDWEST ” Practice Location

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