Organization
ES SD VICTORIAN LLC
Active
Other names
The Victorian
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN UHLIR (CFO)
(530) 242-8300
Entity
Organization
Contact information
Practice address
1321 COLUMBUS ST, RAPID CITY, SD 57701-2505
(605) 342-1913
Mailing address
2334 WASHINGTON AVE STE A, REDDING, CA 96001-2159
(530) 242-8300
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
310400000X
—
SD
Enumeration date
03/26/2018
Last updated
03/26/2018
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