Healthcare Provider Details

I. General information

NPI: 1053526673
Provider Name (Legal Business Name): ABBOTT HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 COURT MERRILL ST
MITCHELL SD
57301-4362
US

IV. Provider business mailing address

909 COURT MERRILL ST
MITCHELL SD
57301-4362
US

V. Phone/Fax

Practice location:
  • Phone: 605-996-2486
  • Fax: 605-996-4585
Mailing address:
  • Phone: 605-996-2486
  • Fax: 605-996-4585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY MOORE
Title or Position: BUSINESS MGR
Credential:
Phone: 605-996-2486