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General NPI Number Information
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NPI Number | 1003088303
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Entity Type | Organization
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Legal Business Name | LOWER BRULE MENTAL HEALTH
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Dates
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Enumeration Date | 03/26/2008
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 187 OYATE CIR
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City | LOWER BRULE
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State | SD
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Zip | 57548-8500
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Country | US
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Telephone | 605-473-8000
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Fax | 605-473-5694
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Provider Business Mailing Address
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Address Line | 187 OYATE CIR
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City | LOWER BRULE
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State | SD
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Zip | 57548-8500
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Country | US
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Telephone | 605-473-8000
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Fax | 605-473-5694
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. JACKIE JANDREAU
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Credential |
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Telephone | 605-473-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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