Provider Demographics
NPI:1568899425
Name:SOUTH DAKOTA HOME CARE, INC.
Entity type:Organization
Organization Name:SOUTH DAKOTA HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-275-0070
Mailing Address - Street 1:1400 W RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-1328
Mailing Address - Country:US
Mailing Address - Phone:605-275-0070
Mailing Address - Fax:605-275-0071
Practice Address - Street 1:1400 W RUSSELL ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-1328
Practice Address - Country:US
Practice Address - Phone:605-275-0070
Practice Address - Fax:605-275-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X
SD253Z00000X
SD1568899425385H00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1568899425Medicaid