Provider Demographics
NPI:1821542101
Name:ROETELL SENIOR HOUSING
Entity Type:Organization
Organization Name:ROETELL SENIOR HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTROR / RN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SIPPEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-532-5430
Mailing Address - Street 1:108 S SMITH ST
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:SD
Mailing Address - Zip Code:57225-1627
Mailing Address - Country:US
Mailing Address - Phone:605-532-5430
Mailing Address - Fax:605-532-5430
Practice Address - Street 1:108 S SMITH ST
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:SD
Practice Address - Zip Code:57225-1627
Practice Address - Country:US
Practice Address - Phone:605-532-5430
Practice Address - Fax:605-532-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11043310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility