Healthcare Provider Details

I. General information

NPI: 1225209711
Provider Name (Legal Business Name): PIERRE INDIAN LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2008
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E SULLY AVE
PIERRE SD
57501-4403
US

IV. Provider business mailing address

3001 E SULLY AVE
PIERRE SD
57501-4403
US

V. Phone/Fax

Practice location:
  • Phone: 605-224-8861
  • Fax: 605-224-0985
Mailing address:
  • Phone: 605-224-8861
  • Fax: 605-224-0985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. DARRELL JEANOTTE
Title or Position: SUPERINTENDENT
Credential:
Phone: 605-224-8661