Provider Demographics
NPI:1750431599
Name:CITY OF HOSMER
Entity type:Organization
Organization Name:CITY OF HOSMER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAURSETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-283-2203
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:HOSMER
Mailing Address - State:SD
Mailing Address - Zip Code:57448-0067
Mailing Address - Country:US
Mailing Address - Phone:605-283-2203
Mailing Address - Fax:605-283-2743
Practice Address - Street 1:307 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:HOSMER
Practice Address - State:SD
Practice Address - Zip Code:57448
Practice Address - Country:US
Practice Address - Phone:605-283-2203
Practice Address - Fax:605-283-2743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10629313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0160190Medicaid
SDS3023Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER