WISDOM IN AGE LLC (NPI# 1346495017) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346495017 |
| Entity Type | Organization |
| Organization Name | WISDOM IN AGE LLC |
| Practice Address |
3704 W Main St Rapid City SD 57702-2139 |
| Practice Telephone | 6057219473 |
| Mailing Telephone | 6057219473 |
| Enumeration Date | 2008-11-23 |
| Last Update Date | 2008-11-23 |
| Authorized Official Name | MS. VICKI L KENNEDY (MANAGER) |
| Authorized Official Telephone | 6057219473 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 311ZA0620X |
Custodial Care Facility Specialization: Adult Care Home |
47608 | SD | Nursing & Custodial Care Facilities |
| Street Address |
3704 W MAIN ST |
| City | RAPID CITY |
| State | SD |
| Zip Code | 57702-2139 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366049660 | Byrne Dental, Professional LLC | Dentist | 3825 Canyon Lake Dr, Rapid City, SD 57702 | 2020-10-08 |
| 1427603026 | Mikaela Licht | Technician | 4310 Cedar Ridge Pl. Apt #5, Rapid City, SD 57702 | 2019-08-09 |
| 1932761335 | Great Plains Tribal Chairmen's Health Board | Pharmacy | Oyate Health Center, 3200 Canyon Lake Drive, Rapid City, SD 57702 | 2019-07-05 |
| 1598231334 | Regional Health Physicians, Inc. | Clinic/Center | 1635 Caregiver Circle, Rapid City, SD 57702 | 2018-10-19 |
| 1851813224 | Angie Deneire | Licensed Practical Nurse | 7312 Pinon Jay Circle, Rapid City, SD 57702 | 2017-07-07 |
| 1073063830 | Kirsten William-kennedy Dds, Ms, P.C. | Dentist | 740 Sheridan Lk. Rd. Suite A, Rapid City, SD 57702 | 2016-10-05 |
| 1932558939 | Emily T Rausch | Physical Therapist | 2040 West Main, #212, Rapid City, SD 57702 | 2016-06-09 |
| 1033597810 | John Dennis Burke | Speech-Language Pathologist | 4635 Wentworth Drive, Rapid City, SD 57702 | 2015-05-12 |
| 1013394535 | Dakota Regional Periodontics | Dentist | 2800 Jackson Blvd #6, Rapid City, SD 57702 | 2015-05-05 |
| 1306272414 | Lindsy Jo Wathen | Speech-Language Pathologist | 13232 Klondike Road, Rapid City, SD 57702 | 2013-09-20 |
| Find all providers in zip 57702 | ||||
| Taxonomy Code | 311ZA0620X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Custodial Care Facility |
| Specialization | Adult Care Home |
| A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770968554 | Convenience Home Health-aide | Custodial Care Facility | 809 N West Ave Apt 305, Sioux Falls, SD 57104-5740 | 2015-07-22 |
| 1578980264 | Vicki Kennedy | Custodial Care Facility | 808 E 3rd St, Dell Rapids, SD 57022-2008 | 2014-03-20 |
| 1841511904 | Avera St Marys | Custodial Care Facility | 801 E Sioux Ave, Pierre, SD 57501 | 2010-06-11 |
| 1982824439 | Health Management Services | Custodial Care Facility | 501 Summit St, Yankton, SD 57078-3855 | 2007-04-26 |
| City | RAPID CITY |
| Zip Code | 57702 |
Please comment or provide details below to improve the information on WISDOM IN AGE LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.