Provider Demographics
NPI:1376682146
Name:WEST RIVER FOUNDATION
Entity Type:Organization
Organization Name:WEST RIVER FOUNDATION
Other - Org Name:DAKOTALINK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COORDINATOR OF TECHNICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:CZERNY
Authorized Official - Suffix:
Authorized Official - Credentials:ATP
Authorized Official - Phone:605-394-6742
Mailing Address - Street 1:1925 N PLAZA BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9302
Mailing Address - Country:US
Mailing Address - Phone:605-394-6742
Mailing Address - Fax:605-394-6744
Practice Address - Street 1:1161 DEADWOOD AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0333
Practice Address - Country:US
Practice Address - Phone:605-394-6742
Practice Address - Fax:695-394-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD53001EST001332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment