Basic Information
| Provider Information | |||||||||
| NPI: | 1336146620 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BRITTON HEALTHCARE, LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | WHEATCREST HILLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 939 | ||||||||
| Address2: | 1311 VANDER HORCK | ||||||||
| City: | BRITTON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574300939 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054482251 | ||||||||
| FaxNumber: | 6054485583 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 VANDER HORCK | ||||||||
| Address2: | |||||||||
| City: | BRITTON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 574302254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6054482251 | ||||||||
| FaxNumber: | 6054485583 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 08/15/2013 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | FURMAN | ||||||||
| AuthorizedOfficialFirstName: | LAVONNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6054482251 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MISSION HEALTHCARE, LLC | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 10599 | SD | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 313M00000X | 10599 | SD | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | 0160600 | 05 | SD | MEDICAID | 9572562 | 01 | SD | MEDICAID ASST LVG/WAIVER | OTHER |