Provider Demographics
NPI:1750407060
Name:CEDAR VILAGE ASSISTED LIVING CENTER
Entity type:Organization
Organization Name:CEDAR VILAGE ASSISTED LIVING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DEPT
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-665-4606
Mailing Address - Street 1:3111 SHIRLEY BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5949
Mailing Address - Country:US
Mailing Address - Phone:605-665-3401
Mailing Address - Fax:605-665-3419
Practice Address - Street 1:3111 SHIRLEY BRIDGE AVE
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5949
Practice Address - Country:US
Practice Address - Phone:605-665-3401
Practice Address - Fax:605-665-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9752630Medicaid