Provider Demographics
NPI:1619163581
Name:AEGIS THERAPIES
Entity Type:Organization
Organization Name:AEGIS THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PTA
Authorized Official - Prefix:MISS
Authorized Official - First Name:ALYSHA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:REMILY
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:605-881-8696
Mailing Address - Street 1:1908 S DOROTHY AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-3866
Mailing Address - Country:US
Mailing Address - Phone:605-425-2253
Mailing Address - Fax:
Practice Address - Street 1:1908 S DOROTHY AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-3866
Practice Address - Country:US
Practice Address - Phone:605-425-2253
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0192314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD=========Medicaid