Provider Demographics
NPI:1104814672
Name:WHITE HEALTHCARE CENTER INC
Entity type:Organization
Organization Name:WHITE HEALTHCARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOWIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GROFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-888-2923
Mailing Address - Street 1:200 PATRICKS AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE
Mailing Address - State:SD
Mailing Address - Zip Code:57276-2047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PATRICKS AVE
Practice Address - Street 2:
Practice Address - City:WHITE
Practice Address - State:SD
Practice Address - Zip Code:57276-2047
Practice Address - Country:US
Practice Address - Phone:605-629-8871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD05001460340865EUT001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9572020Medicaid
SD0160230Medicaid
SD85111OtherBLUE CROSS BLUE SHIELD
SD85111OtherBLUE CROSS BLUE SHIELD