ROSHOLT COUNTRY INN NPI 1871600759

NPI Information

NPI: 1871600759
Provider Name: ROSHOLT COUNTRY INN
Classification: Assisted Living Facility - 310400000X
Entity Type: Organization
Doing Business As: COUNTRYSIDE INN ASSISTED LIVING & MEMORY CARE
CLIA Number: 43D1064935
Address: 208 PRAIRIE AVE
ROSHOLT, SD
ZIP 57260
Phone: (605) 537-4588

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NPI Details

ROSHOLT COUNTRY INN is an assisted living facility in Rosholt, 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. ROSHOLT COUNTRY INN NPI is 1871600759. The provider is registered as an organization entity type.
The provider Is Doing Business As Countryside Inn Assisted Living & Memory Care.

The provider's business location address is:

208 PRAIRIE AVE
ROSHOLT, SD
ZIP 57260-218
Phone: (605) 537-4588
Fax: (605) 537-4890

The provider's authorized official is Charles William Vandeputte .
The authorized official title is Owner - Operator and has the following contact phone number (605) 537-4588.

The CLIA number assigned to this NPI record is 43D1064935 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/24/2006 and was last updated on 8/24/2007.

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	311500000X	Alzheimer Center (Dementia Center)		53737	SOUTH DAKOTA	No
2	310400000X	Assisted Living Facility		53737	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	9570820	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: 11/21/2025

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