Provider Demographics
NPI:1932366291
Name:CACTUS HILLS RETIREMENT
Entity Type:Organization
Organization Name:CACTUS HILLS RETIREMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:NEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-662-5602
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:EDGEMONT
Mailing Address - State:SD
Mailing Address - Zip Code:57735-0689
Mailing Address - Country:US
Mailing Address - Phone:605-662-5602
Mailing Address - Fax:605-662-5189
Practice Address - Street 1:908 H STR
Practice Address - Street 2:
Practice Address - City:EDGEMONT
Practice Address - State:SD
Practice Address - Zip Code:57735-0689
Practice Address - Country:US
Practice Address - Phone:605-662-5602
Practice Address - Fax:605-662-5189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9540290OtherADULT DAY CARE
SD9571140Medicaid