Provider Demographics
NPI:1851560189
Name:SILVER PLAINS ASSISTED LIVING, LLC
Entity Type:Organization
Organization Name:SILVER PLAINS ASSISTED LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN/DIRECTOR OF CARE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BUMANN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-847-4800
Mailing Address - Street 1:610 PARK AVE S
Mailing Address - Street 2:
Mailing Address - City:LAKE PRESTON
Mailing Address - State:SD
Mailing Address - Zip Code:57249-2144
Mailing Address - Country:US
Mailing Address - Phone:605-847-4800
Mailing Address - Fax:
Practice Address - Street 1:610 PARK AVE S
Practice Address - Street 2:
Practice Address - City:LAKE PRESTON
Practice Address - State:SD
Practice Address - Zip Code:57249-2144
Practice Address - Country:US
Practice Address - Phone:605-847-4800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD55956310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570860Medicaid