Provider Demographics
NPI:1922142785
Name:GOOD SAMARITAN - SIOUX VALLEY COMMUNITY HEALTH SERVICES
Entity Type:Organization
Organization Name:GOOD SAMARITAN - SIOUX VALLEY COMMUNITY HEALTH SERVICES
Other - Org Name:PRAIRIE CROSSINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONNENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-882-2045
Mailing Address - Street 1:901 14TH AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-6820
Mailing Address - Country:US
Mailing Address - Phone:605-882-2045
Mailing Address - Fax:605-882-0132
Practice Address - Street 1:424 9TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-4554
Practice Address - Country:US
Practice Address - Phone:605-882-9003
Practice Address - Fax:605-882-9433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10746310400000X
SD10738310400000X
SD40458310400000X
SD10684310400000X
SD11052310400000X
SD41916310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9571950Medicaid
SD9570215Medicaid
SD9570210Medicaid