Provider Demographics
NPI:1639296478
Name:SMAL CORP.
Entity Type:Organization
Organization Name:SMAL CORP.
Other - Org Name:SANDSTONE MANOR ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-4910
Mailing Address - Street 1:2010 WINDMILL DR
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-9475
Mailing Address - Country:US
Mailing Address - Phone:605-642-4910
Mailing Address - Fax:605-642-4910
Practice Address - Street 1:2010 WINDMILL DR
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-9475
Practice Address - Country:US
Practice Address - Phone:605-642-4910
Practice Address - Fax:605-642-4910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDALSD11062310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570810Medicaid