Provider Demographics
NPI:1881851418
Name:GARDEN HILLS ASSISTED LIVING
Entity Type:Organization
Organization Name:GARDEN HILLS ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC TREAS
Authorized Official - Prefix:
Authorized Official - First Name:LUCINDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-642-0404
Mailing Address - Street 1:905 S 34TH ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-9449
Mailing Address - Country:US
Mailing Address - Phone:605-642-0404
Mailing Address - Fax:605-722-1887
Practice Address - Street 1:905 S 34TH ST
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-9449
Practice Address - Country:US
Practice Address - Phone:605-642-0404
Practice Address - Fax:605-722-1887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD11051310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility