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General NPI Number Information
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NPI Number | 1295039220
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Entity Type | Organization
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Legal Business Name | TREC BADLANDS PRENATAL TO FIVE HEAD START
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Dates
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Enumeration Date | 01/05/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 101 5TH AVE
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City | BELLE FOURCHE
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State | SD
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Zip | 57717-1139
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Country | US
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Telephone | 605-723-8837
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Fax | 605-723-8834
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Provider Business Mailing Address
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Address Line | 101 5TH AVE
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City | BELLE FOURCHE
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State | SD
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Zip | 57717-1139
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Country | US
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Telephone | 605-723-8837
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Fax | 605-723-8834
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. DOUGLAS JACOBSON
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Credential | MSW,MBA
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Telephone | 605-723-8837
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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License Number |
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License Number State | SD
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