Provider Demographics
NPI:1154044626
Name:MOUNTAIN FLOWER RETIREMENT HOME LLC
Entity type:Organization
Organization Name:MOUNTAIN FLOWER RETIREMENT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER-MANAGER
Authorized Official - Phone:605-206-1122
Mailing Address - Street 1:1124 2ND ST
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1802
Mailing Address - Country:US
Mailing Address - Phone:605-206-1122
Mailing Address - Fax:
Practice Address - Street 1:1124 2ND ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1802
Practice Address - Country:US
Practice Address - Phone:605-206-1122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-20
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD10691Medicaid