Healthcare Provider Details

I. General information

NPI: 1306606132
Provider Name (Legal Business Name): CHILDRENS HOME SOCIETY OF SOUTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 E 3RD ST
SIOUX FALLS SD
57103-6650
US

IV. Provider business mailing address

PO BOX 1749
SIOUX FALLS SD
57101-1749
US

V. Phone/Fax

Practice location:
  • Phone: 605-334-6004
  • Fax:
Mailing address:
  • Phone: 605-334-6004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: GIBERT JOHNSON
Title or Position: ANALYST
Credential:
Phone: 605-965-3149