Healthcare Provider Details

I. General information

NPI: 1114002573
Provider Name (Legal Business Name): SOUTHEASTERN BEHAVIORAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S SUMMIT AVE
SIOUX FALLS SD
57105
US

IV. Provider business mailing address

2000 S SUMMIT AVE
SIOUX FALLS SD
57105-2727
US

V. Phone/Fax

Practice location:
  • Phone: 605-336-0510
  • Fax:
Mailing address:
  • Phone: 605-336-0510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateSD

VIII. Authorized Official

Name: ROBYN BROWER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 605-336-0510