Provider Demographics
NPI:1376583799
Name:ST. WILLIAM'S CARE CENTER
Entity Type:Organization
Organization Name:ST. WILLIAM'S CARE CENTER
Other - Org Name:ST WILLIAMS HOME
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:THRIFT
Authorized Official - Suffix:
Authorized Official - Credentials:AUTHORIZED OFFICIAL
Authorized Official - Phone:605-432-5811
Mailing Address - Street 1:103 N VIOLA ST
Mailing Address - Street 2:
Mailing Address - City:MILBANK
Mailing Address - State:SD
Mailing Address - Zip Code:57252-1306
Mailing Address - Country:US
Mailing Address - Phone:605-460-0926
Mailing Address - Fax:605-432-3187
Practice Address - Street 1:103 N VIOLA ST
Practice Address - Street 2:
Practice Address - City:MILBANK
Practice Address - State:SD
Practice Address - Zip Code:57252-1306
Practice Address - Country:US
Practice Address - Phone:605-432-5811
Practice Address - Fax:605-432-3187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10737310400000X
SD59176310400000X
SD10649314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0160220Medicaid
SD0160220Medicaid