Eastern Star Home of South Dakota Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

10670 Issued in SD

Legal business name

EASTERN STAR HOME OF SOUTH DAKOTA INC

Practice address

126 W 12TH Ave
Redfield, SD 57469-1522

Phone

(605) 472-0658

Fax

(605) 472-3590

NPI assigned

Jan 9, 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

Mary A Rice

Title

Administrator

Phone

(605) 472-0658

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Eastern Star Home of South Dakota Inc2 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.

• Eastern Star Home of South Dakota Inc.

  • Assisted Living Facility
  • Redfield, SD
  • NPI 1063562437
  NPD tax ID

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730238973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "REDFIELD",
            "state": "SD",
            "postal_code": "574690150",
            "telephone_number": "605-472-0658",
            "fax_number": "605-472-3590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 W 12TH AVE",
            "city": "REDFIELD",
            "state": "SD",
            "postal_code": "574691522",
            "telephone_number": "605-472-0658",
            "fax_number": "605-472-3590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN STAR HOME OF SOUTH DAKOTA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "605-472-0658"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "SD",
            "license": "10670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150120",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Redfield (Redfield Clinic)
• Lisa Cosato
• Karlie R Coyle, COTA
• Dakota Dental Clay Yeoman DDS Prof. LLC
• Dewi Frances Tonelete Depositario-Cabacar, MD
• Eastern Star Home of South Dakota Inc.
• Cathy Frericks, PT
• Olivia Full, DPT
• Rylie Gall
• Melissa Gorecki

• Skilled Nursing Facility in Redfield, SD
• Providers in Redfield, SD by specialty
• Skilled Nursing 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.