Provider Demographics
NPI:1104030717
Name:SUN DIAL MANOR INC
Entity Type:Organization
Organization Name:SUN DIAL MANOR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-492-3615
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:SD
Mailing Address - Zip Code:57219-0337
Mailing Address - Country:US
Mailing Address - Phone:605-492-3615
Mailing Address - Fax:605-492-3616
Practice Address - Street 1:410 2ND ST S
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:SD
Practice Address - Zip Code:57219-0337
Practice Address - Country:US
Practice Address - Phone:605-492-3615
Practice Address - Fax:605-492-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10739310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570060Medicaid