Provider Demographics
NPI:1669607453
Name:SOUTHEAST DAKOTA HOME CARE
Entity type:Organization
Organization Name:SOUTHEAST DAKOTA HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:FAE
Authorized Official - Last Name:JERKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-996-0503
Mailing Address - Street 1:200 E 5TH AVE
Mailing Address - Street 2:STE. 3
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-2652
Mailing Address - Country:US
Mailing Address - Phone:605-996-0503
Mailing Address - Fax:605-996-0310
Practice Address - Street 1:200 E 5TH AVE
Practice Address - Street 2:STE. 3
Practice Address - City:MITCHELL
Practice Address - State:SD
Practice Address - Zip Code:57301-2652
Practice Address - Country:US
Practice Address - Phone:605-996-0503
Practice Address - Fax:605-996-0310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9550620Medicaid