Healthcare Provider Details

I. General information

NPI: 1740790765
Provider Name (Legal Business Name): SHIRLEY B ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 WINFIELD CT
RAPID CITY SD
57701-8306
US

IV. Provider business mailing address

2734 EDEN LN
RAPID CITY SD
57703-6036
US

V. Phone/Fax

Practice location:
  • Phone: 605-415-0792
  • Fax:
Mailing address:
  • Phone: 605-415-0792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier82-2789782
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerDEPTPARTMENT OF TREASURY
# 2
IdentifierDL137092
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerSOUTH DAKOTA SECRETARY OF STATE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: