Provider Demographics
NPI:1336130004
Name:TEKAKWITHA NURSING CENTER INC
Entity Type:Organization
Organization Name:TEKAKWITHA NURSING CENTER INC
Other - Org Name:TEKAKWITHA LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:CORNELIUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-698-7693
Mailing Address - Street 1:6 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-1449
Mailing Address - Country:US
Mailing Address - Phone:605-698-7693
Mailing Address - Fax:605-698-3091
Practice Address - Street 1:6 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-1449
Practice Address - Country:US
Practice Address - Phone:605-698-7693
Practice Address - Fax:605-698-3091
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEDICTINE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-02
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10685314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0150590Medicaid
SD0150590Medicaid