Provider Demographics
NPI:1992745640
Name:DOW RUMMEL VILLAGE
Entity type:Organization
Organization Name:DOW RUMMEL VILLAGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:VAN ROSENDALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-336-1490
Mailing Address - Street 1:1321 W DOW RUMMEL ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-7808
Mailing Address - Country:US
Mailing Address - Phone:605-336-1490
Mailing Address - Fax:605-575-0179
Practice Address - Street 1:1321 W DOW RUMMEL ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-7808
Practice Address - Country:US
Practice Address - Phone:605-336-1490
Practice Address - Fax:605-575-0179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD49739310400000X
SD10678313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1229580001Medicare NSC