THE VICTORIAN ASSISTED LIVING HOME NPI 1629277223

NPI Information

NPI: 1629277223
Provider Name: THE VICTORIAN ASSISTED LIVING HOME
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization

CLIA Number: 43D2247471

Address:
1321 COLUMBUS ST
RAPID CITY, SD
ZIP 57701
Phone: (605) 342-1913
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THE VICTORIAN ASSISTED LIVING HOME is an assisted living facility in Rapid City, SD. The provider is a facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. THE VICTORIAN ASSISTED LIVING HOME NPI is 1629277223. The provider is registered as an organization entity type.

The provider's business location address is:

1321 COLUMBUS ST
RAPID CITY, SD
ZIP 57701-524
Phone: (605) 342-1913
Fax: (605) 348-2870

The provider's authorized official is Lavon Jean Huneke .
The authorized official title is Manager and has the following contact phone number (605) 342-1913.

The CLIA number assigned to this NPI record is 43D2247471 - skilled nursing/nursing facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/13/2007 and was last updated on 7/13/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	310400000X	Assisted Living Facility		11035	SOUTH DAKOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	9570740	MEDICAID	SOUTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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