Provider Demographics
NPI:1982817045
Name:PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN RETIREMENT VILLAGE OF RAPID CITY, INC.
Other - Org Name:THE COURTYARD WESTHILLS VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARYL
Authorized Official - Middle Name:
Authorized Official - Last Name:REINICKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-342-0255
Mailing Address - Street 1:255 TEXAS ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701
Mailing Address - Country:US
Mailing Address - Phone:605-342-6821
Mailing Address - Fax:605-341-3066
Practice Address - Street 1:133 TEXAS ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-342-6821
Practice Address - Fax:605-341-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10753310400000X
SD11045310400000X
SD68559310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9571490Medicaid