South Park Assisted Living, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

41812 Issued in SD

Legal business name

SOUTH PARK ASSISTED LIVING, INC

Practice address

410 S Broadway St
Bryant, SD 57221-2055

Phone

(605) 628-2155

NPI assigned

May 20, 2008

Last updated

May 20, 2008By 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

Ms. Lynalle K Rust

Title

Administrator

Phone

(605) 628-2155

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1211241600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211241600000",
    "number": "1366609067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 S BROADWAY ST",
            "city": "BRYANT",
            "state": "SD",
            "postal_code": "572212055",
            "telephone_number": "605-628-2155",
            "fax_number": "605-628-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 S BROADWAY ST",
            "city": "BRYANT",
            "state": "SD",
            "postal_code": "572212055",
            "telephone_number": "605-628-2155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH PARK ASSISTED LIVING, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-20",
        "last_updated": "2008-05-20",
        "status": "A",
        "authorized_official_last_name": "RUST",
        "authorized_official_first_name": "LYNALLE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "605-628-2155",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "SD",
            "license": "41812",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9572360",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Channel Assisted Living LLC
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• Parkview Assisted Living, Inc

• Assisted Living Facility in Bryant, SD
• Providers in Bryant, 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 May 20, 2008; 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.