Provider Demographics
NPI:1003458993
Name:ISAACS BEHAVIORAL HEALTH, LLC
Entity Type:Organization
Organization Name:ISAACS BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER-PIP
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAACS
Authorized Official - Suffix:
Authorized Official - Credentials:CSW-PIP, LAC, QMHP
Authorized Official - Phone:605-877-2010
Mailing Address - Street 1:11344 US HIGHWAY 212
Mailing Address - Street 2:
Mailing Address - City:BELLE FOURCHE
Mailing Address - State:SD
Mailing Address - Zip Code:57717-6106
Mailing Address - Country:US
Mailing Address - Phone:605-877-2010
Mailing Address - Fax:
Practice Address - Street 1:2650 JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-3474
Practice Address - Country:US
Practice Address - Phone:605-877-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health