Provider Demographics
NPI:1114204096
Name:DEROSIER INC
Entity Type:Organization
Organization Name:DEROSIER INC
Other - Org Name:GARDEN HILLS ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:DEROSIER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:605-642-0404
Mailing Address - Street 1:905 S 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-9449
Mailing Address - Country:US
Mailing Address - Phone:605-642-0404
Mailing Address - Fax:605-722-1887
Practice Address - Street 1:905 S 34TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-9449
Practice Address - Country:US
Practice Address - Phone:605-642-0404
Practice Address - Fax:605-722-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-07
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility