Provider Demographics
NPI:1861480303
Name:TCC HOLDINGS CORPORATION
Entity Type:Organization
Organization Name:TCC HOLDINGS CORPORATION
Other - Org Name:DIAMOND CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-888-2923
Mailing Address - Street 1:901 N MAIN AVE
Mailing Address - Street 2:PO BOX 300
Mailing Address - City:BRIDGEWATER
Mailing Address - State:SD
Mailing Address - Zip Code:57319-2004
Mailing Address - Country:US
Mailing Address - Phone:605-729-2525
Mailing Address - Fax:
Practice Address - Street 1:901 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:SD
Practice Address - Zip Code:57319-2004
Practice Address - Country:US
Practice Address - Phone:605-729-2525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD49737310400000X
SD10597314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9566750Medicaid
SD85115OtherBLUE CROSS BLUE SHIELD
SD9566770Medicaid
SD9570430Medicaid
SD0160352Medicaid
SD9570580Medicaid
SD9566750Medicaid