Provider Demographics
NPI:1487125928
Name:GILLETTE RETIREMENT, L.L.C.
Entity type:Organization
Organization Name:GILLETTE RETIREMENT, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUTENHOFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-725-3859
Mailing Address - Street 1:815 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-2350
Mailing Address - Country:US
Mailing Address - Phone:605-725-3859
Mailing Address - Fax:
Practice Address - Street 1:921 MOUNTAIN MEADOW LN
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-2451
Practice Address - Country:US
Practice Address - Phone:307-682-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management