Provider Demographics
NPI:1982016739
Name:SUNSET MANOR, INC.
Entity Type:Organization
Organization Name:SUNSET MANOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-263-3318
Mailing Address - Street 1:129 E CLAY ST
Mailing Address - Street 2:
Mailing Address - City:IRENE
Mailing Address - State:SD
Mailing Address - Zip Code:57037-2034
Mailing Address - Country:US
Mailing Address - Phone:605-263-3318
Mailing Address - Fax:605-263-3334
Practice Address - Street 1:129 E CLAY ST
Practice Address - Street 2:
Practice Address - City:IRENE
Practice Address - State:SD
Practice Address - Zip Code:57037-2034
Practice Address - Country:US
Practice Address - Phone:605-263-3318
Practice Address - Fax:605-263-3334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10636314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0160110Medicaid
SD435100OtherMEDICARE PTAN