Provider Demographics
NPI:1528606621
Name:THE VILLAGE ASSISTED LIVING
Entity Type:Organization
Organization Name:THE VILLAGE ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-854-9953
Mailing Address - Street 1:401 INGALLS AVE SW
Mailing Address - Street 2:
Mailing Address - City:DE SMET
Mailing Address - State:SD
Mailing Address - Zip Code:57231-2234
Mailing Address - Country:US
Mailing Address - Phone:605-854-9953
Mailing Address - Fax:
Practice Address - Street 1:401 INGALLS AVE SW
Practice Address - Street 2:
Practice Address - City:DE SMET
Practice Address - State:SD
Practice Address - Zip Code:57231-2234
Practice Address - Country:US
Practice Address - Phone:605-854-9953
Practice Address - Fax:605-854-9303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility