MEDICARE: ADULT DAY CENTER OF THE BLACK HILLS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1841030434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT DAY CENTER OF THE BLACK HILLS

Provider Business Mailing Address
First Line	:	4110 WINFIELD CT
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8306
Country	:	US
Telephone Number	:	605-269-0337
Fax Number	:

Provider Business Practice Location Address
First Line	:	4110 WINFIELD CT
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-8306
Country	:	US
Telephone Number	:	605-269-0337
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MELANIE BARCLAY
Credential	:
Telephone Number	:	605-791-0436

Provider Enumeration Date	:	05/30/2024
Last Update Date	:	05/30/2024

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Directions to “ADULT DAY CENTER OF THE BLACK HILLS ” Practice Location

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