Healthcare Provider Details

I. General information

NPI: 1003304205
Provider Name (Legal Business Name): NEW TRAILS MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11455 ELLIOTT RD
CUSTER SD
57730-8239
US

IV. Provider business mailing address

11455 ELLIOTT RD
CUSTER SD
57730-8239
US

V. Phone/Fax

Practice location:
  • Phone: 605-760-3633
  • Fax:
Mailing address:
  • Phone: 605-299-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RODNEY VELDHUIZEN
Title or Position: DIRECTOR
Credential: MFT
Phone: 605-299-1984