Provider Demographics
NPI:1659447563
Name:WINNER REGIONAL HEALTHCARE CENTER
Entity Type:Organization
Organization Name:WINNER REGIONAL HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-842-7100
Mailing Address - Street 1:745 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2677
Mailing Address - Country:US
Mailing Address - Phone:605-842-7100
Mailing Address - Fax:
Practice Address - Street 1:745 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2677
Practice Address - Country:US
Practice Address - Phone:605-842-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD51775314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0159130Medicaid
SD8U043OtherWELLMARK BCBS
SD43Z334Medicare Oscar/Certification