Provider Demographics
NPI:1497009732
Name:WESTERN RESOURCES FOR INDEPENDENT LIVING
Entity Type:Organization
Organization Name:WESTERN RESOURCES FOR INDEPENDENT LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN LOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-718-1930
Mailing Address - Street 1:405 E OMAHA ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2975
Mailing Address - Country:US
Mailing Address - Phone:605-718-1930
Mailing Address - Fax:605-718-1933
Practice Address - Street 1:4110 WINFIELD CT
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8306
Practice Address - Country:US
Practice Address - Phone:605-791-3383
Practice Address - Fax:605-791-3385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No253Z00000XAgenciesIn Home Supportive Care