Healthcare Provider Details

I. General information

NPI: 1689185860
Provider Name (Legal Business Name): ADULT DAY CENTER OF THE BLACK HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 WINFIELD ST
RAPID CITY SD
57701-8306
US

IV. Provider business mailing address

4110 WINFIELD CT
RAPID CITY SD
57701-8306
US

V. Phone/Fax

Practice location:
  • Phone: 605-791-0436
  • Fax: 605-791-1106
Mailing address:
  • Phone: 605-791-0436
  • Fax: 605-791-1106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: MELANIE BARCLAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 605-791-0436