Organization
MEADOW LAKE ASSISTED LIVING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EMIL WIESE (OWNER)
(605) 882-4388
Entity
Organization
Contact information
Practice address
17444 MEADOW LAKE RD, WATERTOWN, SD 57201-9181
(605) 882-4388
(605) 882-4388
Mailing address
17444 MEADOW LAKE RD, WATERTOWN, SD 57201-9181
(605) 882-4388
(605) 882-4388
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
10727
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9570730
—
SD
Enumeration date
03/10/2008
Last updated
03/10/2008
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