Provider Demographics
NPI:1922107887
Name:GARRETSON HEALTHCARE, LLC
Entity Type:Organization
Organization Name:GARRETSON HEALTHCARE, LLC
Other - Org Name:PALISADE HEALTHCARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEREDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA
Authorized Official - Phone:605-594-3466
Mailing Address - Street 1:920 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GARRETSON
Mailing Address - State:SD
Mailing Address - Zip Code:57030-2006
Mailing Address - Country:US
Mailing Address - Phone:605-594-3466
Mailing Address - Fax:605-594-6661
Practice Address - Street 1:920 4TH ST
Practice Address - Street 2:
Practice Address - City:GARRETSON
Practice Address - State:SD
Practice Address - Zip Code:57030-2006
Practice Address - Country:US
Practice Address - Phone:605-594-3466
Practice Address - Fax:605-594-6661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD58297310400000X
SD10623313M00000X, 314000000X
SD10623 SKILLED NURSIN376G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376G00000XNursing Service Related ProvidersNursing Home AdministratorGroup - Single Specialty
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9572780Medicaid
SD0150370Medicaid
SD9572780Medicaid
SD0150370Medicaid