Provider Demographics
NPI:1114915881
Name:VIOLET TSCHETTER MEMORIAL HOME
Entity Type:Organization
Organization Name:VIOLET TSCHETTER MEMORIAL HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-352-8533
Mailing Address - Street 1:PO BOX 946
Mailing Address - Street 2:50 7TH ST SE
Mailing Address - City:HURON
Mailing Address - State:SD
Mailing Address - Zip Code:57350-0946
Mailing Address - Country:US
Mailing Address - Phone:605-352-8533
Mailing Address - Fax:605-352-7742
Practice Address - Street 1:50 7TH ST SE
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:SD
Practice Address - Zip Code:57350
Practice Address - Country:US
Practice Address - Phone:605-352-8533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10634313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0150110Medicaid
SD435126Medicare Oscar/Certification
SD435126Medicare PIN