Provider Demographics
NPI:1922219039
Name:GOOD SAMARITAN SOCIETY HERREID
Entity Type:Organization
Organization Name:GOOD SAMARITAN SOCIETY HERREID
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:RITA
Authorized Official - Last Name:MITZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER LPN
Authorized Official - Phone:605-437-2425
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:806 MAIN STREET NORTH
Mailing Address - City:HERREID
Mailing Address - State:SD
Mailing Address - Zip Code:57632-0008
Mailing Address - Country:US
Mailing Address - Phone:605-437-2425
Mailing Address - Fax:605-437-2950
Practice Address - Street 1:806 MAIN STREET NORTH
Practice Address - Street 2:
Practice Address - City:HERREID
Practice Address - State:SD
Practice Address - Zip Code:57632-0008
Practice Address - Country:US
Practice Address - Phone:605-437-2425
Practice Address - Fax:605-437-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10627310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility