Wakonda Supervised Living Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

11048 Issued in SD

Legal business name

WAKONDA SUPERVISED LIVING INC

Practice address

515 Ohio St
Wakonda, SD 57073-2013

Phone

(605) 267-2081

NPI assigned

May 22, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Becky McManus

Title

Administrator

Phone

(605) 267-2081

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Wakonda Heritage Manor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Wakonda Heritage Manor.

  • Skilled Nursing Facility
  • Wakonda, SD
  • NPI 1003803818
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093924490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 OHIO ST",
            "city": "WAKONDA",
            "state": "SD",
            "postal_code": "570732013",
            "telephone_number": "605-267-2081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 OHIO ST",
            "city": "WAKONDA",
            "state": "SD",
            "postal_code": "570732013",
            "telephone_number": "605-267-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAKONDA SUPERVISED LIVING INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCMANUS",
        "authorized_official_first_name": "BECKY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "605-267-2081"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "11048",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9572190",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lisa Ann Jensen, OTR/L
• Heather Ney, PTA
• Wakonda Heritage Manor.
• Wakonda School District

• Assisted Living Facility in Wakonda, SD
• Providers in Wakonda, SD by specialty
• Assisted Living Facility in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.