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General NPI Number Information
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NPI Number | 1548391022
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Entity Type | Organization
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Legal Business Name | SOUTH DAKOTA DEVELOPMENTAL CENTER
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/25/2023
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Provider Practice Location Address
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Address Line | 17267 W 3RD ST
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City | REDFIELD
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State | SD
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Zip | 57469-1001
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Country | US
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Telephone | 605-472-4231
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Fax | 605-472-4439
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Provider Business Mailing Address
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Address Line | 17267 W 3RD ST
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City | REDFIELD
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State | SD
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Zip | 57469-1001
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Country | US
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Telephone | 605-472-2400
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Fax | 605-472-4457
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | TEAGAN RAE BRULEY
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Credential | PHARMD
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Telephone | 605-472-4231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number |
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License Number State |
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