Provider Demographics
NPI:1184610339
Name:MORNINGSIDE MANOR
Entity type:Organization
Organization Name:MORNINGSIDE MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-934-2011
Mailing Address - Street 1:101 CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:ALCESTER
Mailing Address - State:SD
Mailing Address - Zip Code:54001-0500
Mailing Address - Country:US
Mailing Address - Phone:605-934-2011
Mailing Address - Fax:605-934-9923
Practice Address - Street 1:101 CHURCH ST.
Practice Address - Street 2:
Practice Address - City:ALCESTER
Practice Address - State:SD
Practice Address - Zip Code:54001-0500
Practice Address - Country:US
Practice Address - Phone:605-934-2011
Practice Address - Fax:605-934-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10591313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0150560Medicaid
SD435062Medicare ID - Type Unspecified