Provider Demographics
NPI:1568653004
Name:HIGH PRAIRIE RETIREMENT HOME INC.
Entity Type:Organization
Organization Name:HIGH PRAIRIE RETIREMENT HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANNIE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-892-0082
Mailing Address - Street 1:19129 PRAIRIE HILLS RD
Mailing Address - Street 2:
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-6107
Mailing Address - Country:US
Mailing Address - Phone:605-892-0082
Mailing Address - Fax:
Practice Address - Street 1:19129 PRAIRIE HILLS RD
Practice Address - Street 2:
Practice Address - City:BELLE FOURCHE
Practice Address - State:SD
Practice Address - Zip Code:57717-6107
Practice Address - Country:US
Practice Address - Phone:605-892-0082
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10720310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility