Provider Demographics
NPI:1083825707
Name:ST. WILLIAM'S HOME
Entity Type:Organization
Organization Name:ST. WILLIAM'S HOME
Other - Org Name:ANGELA HALL ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:LEROUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-432-3171
Mailing Address - Street 1:100 SOUTH 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-2105
Mailing Address - Country:US
Mailing Address - Phone:605-432-5811
Mailing Address - Fax:605-432-3187
Practice Address - Street 1:100 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-2105
Practice Address - Country:US
Practice Address - Phone:605-432-5811
Practice Address - Fax:605-432-3187
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. WILLIAM'S HOME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-24
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10737310400000X
SD10649310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9571350Medicaid
SD0160220Medicaid
SD435122Medicaid