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43D2104898 CLIA NUMBER - GRACE OF THE PINES HOSPICE LLC

Laboratory Demographics

CLIA Number: 43D2104898

Facility Name: GRACE OF THE PINES HOSPICE LLC

Facility Address:
3117 WEST RAPID ST SUITE 5
RAPID CITY, SD
ZIP 57702
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Facility Phone Number: 605 745-4967

Facility Type: Hospice

Certificate Type: Waiver
NPI Number: 1891168746

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 43D2104898
LAB Type Hospice
Facility Name GRACE OF THE PINES HOSPICE LLC
Street 3117 WEST RAPID ST SUITE 5
City RAPID CITY
State SD
ZIP 57702
Phone 605 745-4967
CertificateType 4
CertificateEffectiveDate 11/16/2023
CertificateExpirationDate 11/15/2025
FacilityType Waiver

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This page was last updated on: 4/23/2024