Healthcare Provider Details

I. General information

NPI: 1518039627
Provider Name (Legal Business Name): GREAT PLAINS AREA YOUTH REGIONAL TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12451 HIGHWAY 1806
MOBRIDGE SD
57601-0680
US

IV. Provider business mailing address

PO BOX 680 12451 HIGHWAY 1806
MOBRIDGE SD
57601-0680
US

V. Phone/Fax

Practice location:
  • Phone: 605-845-7181
  • Fax: 605-845-5072
Mailing address:
  • Phone: 605-845-7181
  • Fax: 605-845-5072

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 Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: DELAINE KELLER
Title or Position: MEDICAL SUPPORT ASSISTANT
Credential:
Phone: 605-845-7181