Basic Information
| Provider Information | |||||||||
| NPI: | 1265680474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | STATE HOME CARE SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 E 20TH ST | ||||||||
| Address2: | SUITE 317 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053353373 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 E 20TH ST | ||||||||
| Address2: | SUITE 317 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053353373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2008 | ||||||||
| LastUpdateDate: | 08/29/2008 | ||||||||
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| AuthorizedOfficialLastName: | BEEDLE | ||||||||
| AuthorizedOfficialFirstName: | ANDREW | ||||||||
| AuthorizedOfficialMiddleName: | PATRICK | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6053353373 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | SD | Y | Agencies | Home Health |
No ID Information.