Organization
SOUTH PARK ASSISTED LIVING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNALLE K RUST (ADMINISTRATOR)
(605) 628-2155
Entity
Organization
Contact information
Practice address
410 S BROADWAY ST, BRYANT, SD 57221-2055
(605) 628-2155
Mailing address
410 S BROADWAY ST, BRYANT, SD 57221-2055
(605) 628-2155
(605) 628-2095
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
41812
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9572360
—
SD
Enumeration date
05/20/2008
Last updated
05/20/2008
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