Organization
KINGSBURY MEMORIAL MANOR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HOWIE GROFF (PRESIDENT)
(952) 888-2923
Entity
Organization
Contact information
Practice address
703 4TH ST SE, LAKE PRESTON, SD 57249-2116
(605) 847-4405
Mailing address
703 4TH ST SE, LAKE PRESTON, SD 57249-2116
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
10640
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0151270
—
SD
01
—
85067
WELLMARK
SD
Enumeration date
02/02/2006
Last updated
08/22/2020
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