Provider Demographics
NPI:1104084466
Name:LEISURE LIVING II, INC
Entity type:Organization
Organization Name:LEISURE LIVING II, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SABERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-770-2500
Mailing Address - Street 1:27 ARROWHEAD PASS
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-5073
Mailing Address - Country:US
Mailing Address - Phone:605-770-2500
Mailing Address - Fax:605-292-0228
Practice Address - Street 1:305 W 5TH ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033-2275
Practice Address - Country:US
Practice Address - Phone:605-528-7406
Practice Address - Fax:
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
SD41964310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570660Medicaid