MEDICARE: NORTHERN HILLS ALCOHOL AND DRUG SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	324500000X	Substance Abuse Rehabilitation Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013057330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN HILLS ALCOHOL AND DRUG SERVICES

Provider Business Mailing Address
First Line	:	1807 WILLIAMS ST
Second Line	:	PO BOX 277
City	:	STURGIS
State	:	SD
Zip	:	57785-1142
Country	:	US
Telephone Number	:	605-347-3003
Fax Number	:	605-347-4944

Provider Business Practice Location Address
First Line	:	1010 BALLPARK RD
Second Line	:
City	:	STURGIS
State	:	SD
Zip	:	57785-2364
Country	:	US
Telephone Number	:	605-347-3003
Fax Number	:	605-347-4944

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MARY KATHERINE WOOD-FOSSEN
Credential	:	BS CCDC III
Telephone Number	:	605-347-3003

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	04/18/2017

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