Provider Demographics
NPI:1326020108
Name:KISMET ELK LLC
Entity Type:Organization
Organization Name:KISMET ELK LLC
Other - Org Name:WEL HOME HEALTH ELK POINT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-7736
Mailing Address - Street 1:600 E LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-2284
Mailing Address - Country:US
Mailing Address - Phone:605-356-3894
Mailing Address - Fax:
Practice Address - Street 1:600 E LINCOLN ST
Practice Address - Street 2:
Practice Address - City:ELK POINT
Practice Address - State:SD
Practice Address - Zip Code:57025-2284
Practice Address - Country:US
Practice Address - Phone:605-356-3894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0171480Medicaid
SD0171480Medicaid