Provider Demographics
NPI:1043422918
Name:REGIONAL HEALTH NETWORK INC
Entity Type:Organization
Organization Name:REGIONAL HEALTH NETWORK INC
Other - Org Name:FAIRMONT GRAND REGIONAL SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO REGIONAL HEALTH NETWORK
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GIESEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-719-8706
Mailing Address - Street 1:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57709
Mailing Address - Country:US
Mailing Address - Phone:605-399-1551
Mailing Address - Fax:
Practice Address - Street 1:409 E FAIRLANE DRIVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-399-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10760310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD10760OtherLICENSE