MEDICARE: ANCHOR'D RECOVERY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center
3	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
4	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1366309700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCHOR'D RECOVERY, INC

Provider Business Mailing Address
First Line	:	1809 N WISCONSIN ST
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-1067
Country	:	US
Telephone Number	:	605-990-3733
Fax Number	:	605-990-3733

Provider Business Practice Location Address
First Line	:	1809 N WISCONSIN ST
Second Line	:
City	:	MITCHELL
State	:	SD
Zip	:	57301-1067
Country	:	US
Telephone Number	:	605-990-3733
Fax Number	:	605-990-3733

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	JAI MIMMACK
Credential	:	ACT
Telephone Number	:	605-990-3733

Provider Enumeration Date	:	01/07/2026
Last Update Date	:	01/07/2026

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