Healthcare Provider Details

I. General information

NPI: 1144358433
Provider Name (Legal Business Name): SKY RANCH FOR BOYS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SKY RANCH LN
SKY RANCH SD
57724-9401
US

IV. Provider business mailing address

100 SKY RANCH LN
SKY RANCH SD
57724-9401
US

V. Phone/Fax

Practice location:
  • Phone: 605-797-4422
  • Fax: 605-797-4425
Mailing address:
  • Phone: 605-797-4422
  • Fax: 605-797-4425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License NumberR57 97,326
License Number StateSD

VIII. Authorized Official

Name: SCOTT LOUKS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 605-797-4422