MEDICARE: HIGH PRAIRIE RETIREMENT HOME 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	310400000X	Assisted Living Facility	10720	SD

General Provider Information

NPI Number	:	1568653004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH PRAIRIE RETIREMENT HOME INC.

Provider Business Mailing Address
First Line	:	19129 PRAIRIE HILLS RD
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-6107
Country	:	US
Telephone Number	:	605-892-0082
Fax Number	:

Provider Business Practice Location Address
First Line	:	19129 PRAIRIE HILLS RD
Second Line	:
City	:	BELLE FOURCHE
State	:	SD
Zip	:	57717-6107
Country	:	US
Telephone Number	:	605-892-0082
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. JEANNIE KATHLEEN BATES
Credential	:
Telephone Number	:	605-892-0082

Provider Enumeration Date	:	08/08/2007
Last Update Date	:	08/08/2007

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