Provider Demographics
NPI:1851361828
Name:PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.
Other - Org Name:WESTHILLS VILLAGE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:REINICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-342-0255
Mailing Address - Street 1:255 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7362
Mailing Address - Country:US
Mailing Address - Phone:605-342-0255
Mailing Address - Fax:605-394-3605
Practice Address - Street 1:255 TEXAS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7362
Practice Address - Country:US
Practice Address - Phone:605-342-0255
Practice Address - Fax:605-394-3605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-24
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10721314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD435033Medicare Oscar/Certification
SD85033Medicare UPIN