Healthcare Provider Details

I. General information

NPI: 1811017155
Provider Name (Legal Business Name): CHILDRENS HOME SOCIETY OF SOUTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N SYCAMORE AVE
SIOUX FALLS SD
57110-5746
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: 605-335-2776
Mailing address:
  • Phone: 605-334-6004
  • Fax: 605-335-2776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberR51
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License NumberR45
License Number StateSD

VIII. Authorized Official

Name: BILL COLSON
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 605-334-6004