Provider Demographics
NPI:1154015873
Name:AMERICAN BAPTIST OF THE MIDWEST FOUNDATION
Entity type:Organization
Organization Name:AMERICAN BAPTIST OF THE MIDWEST FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HOME CARE
Authorized Official - Prefix:
Authorized Official - First Name:REBAKAH
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEHAAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-231-8141
Mailing Address - Street 1:3408 W RALPH ROGERS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2683
Mailing Address - Country:US
Mailing Address - Phone:605-231-8141
Mailing Address - Fax:605-373-0088
Practice Address - Street 1:3408 W RALPH ROGERS RD STE 200
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2683
Practice Address - Country:US
Practice Address - Phone:605-231-8141
Practice Address - Fax:605-373-0088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMERICAN BAPTIST HOMES OF THE MIDWEST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-06
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD410706155Medicaid