Provider Demographics
NPI:1821446253
Name:OGLALA SIOUX LAKOTA NURSING HOME, INC
Entity Type:Organization
Organization Name:OGLALA SIOUX LAKOTA NURSING HOME, INC
Other - Org Name:OGLALA SIOUX LAKOTA NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POURIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-899-0823
Mailing Address - Street 1:DRIVE 7835 STATE HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:NE
Mailing Address - Zip Code:69360-0000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7835 STATE HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:NE
Practice Address - Zip Code:69360-0001
Practice Address - Country:US
Practice Address - Phone:605-899-0823
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility