Provider Demographics
NPI:1184826547
Name:GREGORY ASSISTED LIVING
Entity Type:Organization
Organization Name:GREGORY ASSISTED LIVING
Other - Org Name:SILVER THREADS RESIDENCE
Other - Org Type:Other Name
Authorized Official - Title/Position:RESIDENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARTLING
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:605-835-9717
Mailing Address - Street 1:210 E 12TH STREET
Mailing Address - Street 2:
Mailing Address - City:GREGORY
Mailing Address - State:SD
Mailing Address - Zip Code:57533
Mailing Address - Country:US
Mailing Address - Phone:605-835-9717
Mailing Address - Fax:605-835-9719
Practice Address - Street 1:210 E 12TH STREET
Practice Address - Street 2:
Practice Address - City:GREGORY
Practice Address - State:SD
Practice Address - Zip Code:57533
Practice Address - Country:US
Practice Address - Phone:605-835-9717
Practice Address - Fax:605-835-9719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9571420Medicaid
SD9571420Medicare ID - Type Unspecified