Organization
ROSHOLT COUNTRY INN
Active
Other names
Countryside Inn Assisted Living & Memory Care
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES WILLIAM VANDEPUTTE (OWNER - OPERATOR)
(605) 537-4588
Entity
Organization
Contact information
Practice address
208 PRAIRIE AVE, ROSHOLT, SD 57260-0218
(605) 537-4588
(605) 537-4890
Mailing address
208 PRAIRIE AVE, PO BOX 218, ROSHOLT, SD 57260-0218
(605) 537-4588
(605) 537-4890
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
53737
SD
311500000X
Alzheimer Center (Dementia Center)
53737
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9570820
—
SD
Enumeration date
08/24/2006
Last updated
08/24/2007
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