=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366309700
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANCHOR'D RECOVERY, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2026
-----------------------------------------------------
Last Update Date | 01/07/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1809 N WISCONSIN ST
-----------------------------------------------------
City | MITCHELL
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57301-1067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-990-3733
-----------------------------------------------------
Fax | 605-990-3733
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1809 N WISCONSIN ST
-----------------------------------------------------
City | MITCHELL
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57301-1067
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-990-3733
-----------------------------------------------------
Fax | 605-990-3733
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | JAI MIMMACK
-----------------------------------------------------
Credential | ACT
-----------------------------------------------------
Telephone | 605-990-3733
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QR0405X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 276400000X
-----------------------------------------------------
Taxonomy Name | Substance Use Disorder Rehabilitation Hospital Unit
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 324500000X
-----------------------------------------------------
Taxonomy Name | Substance Abuse Rehabilitation Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------