Healthcare Provider Details

I. General information

NPI: 1457504649
Provider Name (Legal Business Name): SOUTH DAKOTA ACHIEVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2008
Last Update Date: 10/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 S WESTERN AVE
SIOUX FALLS SD
57105-6620
US

IV. Provider business mailing address

4100 S WESTERN AVE
SIOUX FALLS SD
57105-6620
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-7100
  • Fax: 605-338-0259
Mailing address:
  • Phone: 605-336-7100
  • Fax: 605-338-0259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name: MRS. EDIE KAVANAGH
Title or Position: DIRECTOR OF SERVICE COORDINATION
Credential:
Phone: 605-274-1356