Provider Demographics
NPI:1821185414
Name:ST BENEDICT HEALTH CENTER
Entity Type:Organization
Organization Name:ST BENEDICT HEALTH CENTER
Other - Org Name:AVERA ST BENEDICT ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-928-3311
Mailing Address - Street 1:401 W GLYNN DRIVE
Mailing Address - Street 2:
Mailing Address - City:PARKSTON
Mailing Address - State:SD
Mailing Address - Zip Code:57366
Mailing Address - Country:US
Mailing Address - Phone:605-928-3311
Mailing Address - Fax:605-928-7368
Practice Address - Street 1:401 W GLYNN DRIVE
Practice Address - Street 2:
Practice Address - City:PARKSTON
Practice Address - State:SD
Practice Address - Zip Code:57366
Practice Address - Country:US
Practice Address - Phone:605-928-3311
Practice Address - Fax:605-928-7368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10659310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570160Medicaid