Provider Demographics
NPI:1497743603
Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Entity Type:Organization
Organization Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Other - Org Name:TRAIL RIDGE RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF RESIDENT RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-639-3008
Mailing Address - Street 1:3408 W RALPH ROGERS RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2602
Mailing Address - Country:US
Mailing Address - Phone:605-339-9123
Mailing Address - Fax:605-339-0080
Practice Address - Street 1:3408 W RALPH ROGERS RD
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2602
Practice Address - Country:US
Practice Address - Phone:605-339-9123
Practice Address - Fax:605-373-2602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10744310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570720Medicaid