Provider Demographics
NPI:1154367571
Name:AURORA BRULE NURSING HOME, INC.
Entity type:Organization
Organization Name:AURORA BRULE NURSING HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TERASA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GILLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-249-2216
Mailing Address - Street 1:408 S. JOHNSTON ST.
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:SD
Mailing Address - Zip Code:57383
Mailing Address - Country:US
Mailing Address - Phone:605-249-2216
Mailing Address - Fax:605-249-2599
Practice Address - Street 1:408 S. JOHNSTON ST.
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:SD
Practice Address - Zip Code:57383
Practice Address - Country:US
Practice Address - Phone:605-249-2216
Practice Address - Fax:605-249-2599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10709314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0160020Medicaid
SD9570040OtherASSISTED LIVING WAVIER
SD0160020Medicaid