Provider Demographics
NPI:1003088303
Name:LOWER BRULE MENTAL HEALTH
Entity Type:Organization
Organization Name:LOWER BRULE MENTAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JANDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-473-8000
Mailing Address - Street 1:187 OYATE CIR
Mailing Address - Street 2:
Mailing Address - City:LOWER BRULE
Mailing Address - State:SD
Mailing Address - Zip Code:57548-8500
Mailing Address - Country:US
Mailing Address - Phone:605-473-8000
Mailing Address - Fax:605-473-5694
Practice Address - Street 1:187 OYATE CIR
Practice Address - Street 2:
Practice Address - City:LOWER BRULE
Practice Address - State:SD
Practice Address - Zip Code:57548-8500
Practice Address - Country:US
Practice Address - Phone:605-473-8000
Practice Address - Fax:605-473-5694
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOWER BRULE SIOUX TRIBE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health