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General NPI Number Information
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NPI Number | 1063602365
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Entity Type | Organization
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Legal Business Name | ROSEBUD SIOUX TRIBE ALCOHOL DRUG TREATMENT PROGRAM
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Dates
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Enumeration Date | 08/01/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | #7 HOSPITAL LANE
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City | ROSEBUD
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State | SD
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Zip | 57570
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Country | US
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Telephone | 605-747-2342
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Fax | 605-747-2111
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Provider Business Mailing Address
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Address Line | PO BOX 348, #7 HOSPITAL LANE
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City | ROSEBUD
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State | SD
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Zip | 57570
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Country | US
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Telephone | 605-747-2342
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Fax | 605-747-2111
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. MARCIDA BEATRICE EAGLE BEAR
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Credential | M.A., CCDCIII
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Telephone | 605-747-2342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number |
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License Number State |
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