Provider Demographics
NPI:1083813794
Name:WINNER RETIREMENT CENTER L.L.C.
Entity Type:Organization
Organization Name:WINNER RETIREMENT CENTER L.L.C.
Other - Org Name:GOLDEN PRAIRIE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-842-0508
Mailing Address - Street 1:1145 GOLDEN PRAIRIE DR
Mailing Address - Street 2:#400
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2171
Mailing Address - Country:US
Mailing Address - Phone:605-842-0508
Mailing Address - Fax:605-842-2803
Practice Address - Street 1:1145 GOLDEN PRAIRIE DR
Practice Address - Street 2:#400
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2171
Practice Address - Country:US
Practice Address - Phone:605-842-0508
Practice Address - Fax:605-842-2803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11087310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9572610Medicaid