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NPI Code Detail

MEDICARE: MR. GALEN ALDEAN GROVE CCDC-IIIR

MEDICARE: MR. GALEN ALDEAN GROVE CCDC-IIIR
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1962414870
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GALEN ALDEAN GROVE CCDC-IIIR
Provider Business Mailing Address
First Line : 771 10TH ST SW
Second Line :
City : HURON
State : SD
Zip : 57350-3061
Country : US
Telephone Number : 605-352-7405
Fax Number :
Provider Business Practice Location Address
First Line : 357 KANSAS AVE SE
Second Line :
City : HURON
State : SD
Zip : 57350-2517
Country : US
Telephone Number : 605-352-8596
Fax Number : 605-352-7001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 07/08/2007

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