Provider Demographics
NPI:1538231048
Name:ROSHOLT NURSING INC.
Entity type:Organization
Organization Name:ROSHOLT NURSING INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-537-4272
Mailing Address - Street 1:85 1ST AVENUE EAST
Mailing Address - Street 2:
Mailing Address - City:ROSHOLT
Mailing Address - State:SD
Mailing Address - Zip Code:57260-0108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:85 FIRST AVENUE EAST
Practice Address - Street 2:
Practice Address - City:ROSHOLT
Practice Address - State:SD
Practice Address - Zip Code:57260-0108
Practice Address - Country:US
Practice Address - Phone:605-537-4272
Practice Address - Fax:605-537-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10672314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9580600Medicaid
SD435121Medicare ID - Type Unspecified