Provider Demographics
NPI:1922176684
Name:WESTERN SD SENIOR SERVICES INC
Entity Type:Organization
Organization Name:WESTERN SD SENIOR SERVICES INC
Other - Org Name:MEALS PROGRAM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-394-6002
Mailing Address - Street 1:303 NORTH MAPLE AVENUE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1538
Mailing Address - Country:US
Mailing Address - Phone:605-394-6002
Mailing Address - Fax:605-394-6001
Practice Address - Street 1:303 NORTH MAPLE AVENUE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1538
Practice Address - Country:US
Practice Address - Phone:605-394-6002
Practice Address - Fax:605-394-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9580230Medicaid