Provider Demographics
NPI:1174663942
Name:1208 JENNINGS, INC.
Entity Type:Organization
Organization Name:1208 JENNINGS, INC.
Other - Org Name:HOMEWATCH CAREGIVERS OF SOUTH DAKOTA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:605-275-6688
Mailing Address - Street 1:326 E 8TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-7029
Mailing Address - Country:US
Mailing Address - Phone:605-275-6688
Mailing Address - Fax:605-275-6686
Practice Address - Street 1:326 E 8TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-7029
Practice Address - Country:US
Practice Address - Phone:605-275-6688
Practice Address - Fax:605-275-6686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5195070Medicaid