Provider Demographics
NPI:1518125244
Name:SPRINGFIELD ASSISTED LIVING CENTER
Entity Type:Organization
Organization Name:SPRINGFIELD ASSISTED LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOOKKEEPER
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:DRAUGHON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-369-5445
Mailing Address - Street 1:701 PINE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:SD
Mailing Address - Zip Code:57062-2129
Mailing Address - Country:US
Mailing Address - Phone:605-369-5445
Mailing Address - Fax:605-369-2868
Practice Address - Street 1:701 PINE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:SD
Practice Address - Zip Code:57062-2129
Practice Address - Country:US
Practice Address - Phone:605-369-5445
Practice Address - Fax:605-369-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD00000000000000000000302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9572460Medicare Oscar/Certification