Healthcare Provider Details

I. General information

NPI: 1386911923
Provider Name (Legal Business Name): DAKOTAHAVEN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 ORCHARD DR
BROOKINGS SD
57006-3247
US

IV. Provider business mailing address

1513 ORCHARD DR
BROOKINGS SD
57006-3247
US

V. Phone/Fax

Practice location:
  • Phone: 605-212-0894
  • Fax:
Mailing address:
  • Phone: 605-212-0894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1096
License Number StateSD

VIII. Authorized Official

Name: DR. KARLA MARIE HUNTER
Title or Position: OWNER
Credential:
Phone: 605-212-0894