Provider Demographics
NPI:1336309939
Name:COLOME'S ROSE MANOR
Entity Type:Organization
Organization Name:COLOME'S ROSE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PS
Authorized Official - Last Name:STANDS BY EAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-842-0234
Mailing Address - Street 1:317 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLOME
Mailing Address - State:SD
Mailing Address - Zip Code:57528-2101
Mailing Address - Country:US
Mailing Address - Phone:605-842-0234
Mailing Address - Fax:605-842-0323
Practice Address - Street 1:317 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLOME
Practice Address - State:SD
Practice Address - Zip Code:57528-2101
Practice Address - Country:US
Practice Address - Phone:605-842-0234
Practice Address - Fax:605-842-0323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9571970Medicaid