Healthcare Provider Details

I. General information

NPI: 1598403297
Provider Name (Legal Business Name): ERIC GROVER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13377 SILVER MOUNTAIN RD
RAPID CITY SD
57702-6542
US

IV. Provider business mailing address

13381 SILVER MOUNTAIN RD
RAPID CITY SD
57702-6542
US

V. Phone/Fax

Practice location:
  • Phone: 605-209-9195
  • Fax:
Mailing address:
  • Phone: 605-209-9195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6626
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: