Provider Demographics
NPI:1730347097
Name:SALEM ELDERLY LIVING LLC
Entity type:Organization
Organization Name:SALEM ELDERLY LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SABERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-770-2500
Mailing Address - Street 1:27 ARROWHEAD PASS
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:SD
Mailing Address - Zip Code:57301-5073
Mailing Address - Country:US
Mailing Address - Phone:605-770-2500
Mailing Address - Fax:605-292-0228
Practice Address - Street 1:600 S HILL ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:SD
Practice Address - Zip Code:57058-8707
Practice Address - Country:US
Practice Address - Phone:605-425-2858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD42874310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9570610Medicaid