Provider Demographics
NPI:1770780140
Name:KADOKA NURSING HOME ASS.
Entity type:Organization
Organization Name:KADOKA NURSING HOME ASS.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUBY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANFTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-837-2270
Mailing Address - Street 1:103 MAPLE ST, W
Mailing Address - Street 2:P.O.BOX 310
Mailing Address - City:KADOKA
Mailing Address - State:SD
Mailing Address - Zip Code:57543-0310
Mailing Address - Country:US
Mailing Address - Phone:605-837-2270
Mailing Address - Fax:605-837-2201
Practice Address - Street 1:103 MAPLE ST, W
Practice Address - Street 2:
Practice Address - City:KADOKA
Practice Address - State:SD
Practice Address - Zip Code:57543-0310
Practice Address - Country:US
Practice Address - Phone:605-837-2270
Practice Address - Fax:605-837-2201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10637313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0160290Medicaid