Provider Demographics
NPI:1588277099
Name:YANKTON AW
Entity type:Organization
Organization Name:YANKTON AW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LETHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARIENAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-689-0439
Mailing Address - Street 1:300 E 6T HST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SC
Mailing Address - Zip Code:57078-5123
Mailing Address - Country:US
Mailing Address - Phone:605-689-0439
Mailing Address - Fax:605-689-2035
Practice Address - Street 1:2903 DOUGLAS AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-4888
Practice Address - Country:US
Practice Address - Phone:605-668-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-25
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility