Provider Demographics
NPI:1740438670
Name:GOOD SAMARITAN SOCIETY-ECHO RIDGE
Entity type:Organization
Organization Name:GOOD SAMARITAN SOCIETY-ECHO RIDGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-718-1800
Mailing Address - Street 1:931 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-2386
Mailing Address - Country:US
Mailing Address - Phone:605-718-1800
Mailing Address - Fax:605-718-1801
Practice Address - Street 1:931 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-2386
Practice Address - Country:US
Practice Address - Phone:605-718-1800
Practice Address - Fax:605-718-1801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GOOD SAMARITAN SOCIETY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD46860310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility