Provider Demographics
NPI:1851373138
Name:UNITED RETIREMENT CENTER
Entity Type:Organization
Organization Name:UNITED RETIREMENT CENTER
Other - Org Name:UNITED LIVING COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:567-344-0346
Mailing Address - Street 1:405 1ST AVE
Mailing Address - Street 2:UNITED LIVING COMMUNITY
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1835
Mailing Address - Country:US
Mailing Address - Phone:605-692-5351
Mailing Address - Fax:605-692-3556
Practice Address - Street 1:405 1ST AVE
Practice Address - Street 2:UNITED LIVING COMMUNITY
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-1835
Practice Address - Country:US
Practice Address - Phone:605-692-5351
Practice Address - Fax:605-692-3556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10601314000000X
SD0160050314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0160050Medicaid
SD0160050Medicaid
SD0160050Medicaid