Provider Demographics
NPI:1457425704
Name:MITCHELL HEALTHCARE, LLC
Entity Type:Organization
Organization Name:MITCHELL HEALTHCARE, LLC
Other - Org Name:FIRESTEEL HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOERBOOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-873-7907
Mailing Address - Street 1:1120 E 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2908
Mailing Address - Country:US
Mailing Address - Phone:605-996-6526
Mailing Address - Fax:605-996-8290
Practice Address - Street 1:1120 E 7TH AVE
Practice Address - Street 2:
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2908
Practice Address - Country:US
Practice Address - Phone:605-996-6526
Practice Address - Fax:605-996-8290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-20
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10653251J00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0150912Medicaid
SD435109Medicare Oscar/Certification