Provider Demographics
NPI:1821099102
Name:KISMET ELK LLC
Entity Type:Organization
Organization Name:KISMET ELK LLC
Other - Org Name:PRAIRIE ESTATES CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-7736
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:600 S. FRANKLIN
Mailing Address - City:ELK POINT
Mailing Address - State:SD
Mailing Address - Zip Code:57025-0486
Mailing Address - Country:US
Mailing Address - Phone:605-356-2622
Mailing Address - Fax:
Practice Address - Street 1:600 SOUTH FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:ELK POINT
Practice Address - State:SD
Practice Address - Zip Code:57025-0486
Practice Address - Country:US
Practice Address - Phone:605-356-2622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10615314000000X
385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1821099102Medicaid
SD435065Medicare ID - Type Unspecified