Provider Demographics
NPI:1356311716
Name:FIVE COUNTIES HOSPITAL & NURSING HOME
Entity Type:Organization
Organization Name:FIVE COUNTIES HOSPITAL & NURSING HOME
Other - Org Name:LEMMON AREA MEDICAL ASSOCIATION
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING/ACCOUNTS RECEIVABLE
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-374-3871
Mailing Address - Street 1:405 6TH AVE. W. PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:LEMMON
Mailing Address - State:SD
Mailing Address - Zip Code:57638-0479
Mailing Address - Country:US
Mailing Address - Phone:605-374-3871
Mailing Address - Fax:605-374-3169
Practice Address - Street 1:405 6TH AVE. W.
Practice Address - Street 2:
Practice Address - City:LEMMON
Practice Address - State:SD
Practice Address - Zip Code:57638-0479
Practice Address - Country:US
Practice Address - Phone:605-374-3871
Practice Address - Fax:605-374-3169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-26
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10641313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0151200Medicaid