Provider Demographics
NPI:1750386660
Name:RAPID CITY HEALTHCARE, LLC
Entity type:Organization
Organization Name:RAPID CITY HEALTHCARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:2000 WESLEYAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-9340
Mailing Address - Country:US
Mailing Address - Phone:605-343-3555
Mailing Address - Fax:605-348-1979
Practice Address - Street 1:2000 WESLEYAN BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-9340
Practice Address - Country:US
Practice Address - Phone:605-343-3555
Practice Address - Fax:605-348-1979
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSION HEALTHCARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-16
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10723314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0151303Medicaid
SD0151302Medicaid
SD435110Medicare ID - Type UnspecifiedMEDICARE