Provider Demographics
NPI:1225074164
Name:DELL RAPIDS NRSG. HOME INC.
Entity Type:Organization
Organization Name:DELL RAPIDS NRSG. HOME INC.
Other - Org Name:TERRACE MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:LJUNGGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-428-5478
Mailing Address - Street 1:1400 THRESHER DR
Mailing Address - Street 2:
Mailing Address - City:DELL RAPIDS
Mailing Address - State:SD
Mailing Address - Zip Code:57022-1049
Mailing Address - Country:US
Mailing Address - Phone:605-428-5478
Mailing Address - Fax:605-428-4521
Practice Address - Street 1:1400 THRESHER DR
Practice Address - Street 2:
Practice Address - City:DELL RAPIDS
Practice Address - State:SD
Practice Address - Zip Code:57022-1049
Practice Address - Country:US
Practice Address - Phone:605-428-5478
Practice Address - Fax:605-428-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10613313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0150080Medicaid