Provider Demographics
NPI:1417994526
Name:LEMMON AREA MEDICAL ASSOCIATION
Entity Type:Organization
Organization Name:LEMMON AREA MEDICAL ASSOCIATION
Other - Org Name:FIVE COUNTIES NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN BEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-374-3871
Mailing Address - Street 1:405 6TH AVE W
Mailing Address - Street 2:PO BOX 479
Mailing Address - City:LEMMON
Mailing Address - State:SD
Mailing Address - Zip Code:57638-1318
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:57638-1318
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:2006-05-31
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10641314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD435090Medicare ID - Type UnspecifiedMEDICARE NH SNF, THERAPYS