Provider Demographics
NPI:1003932682
Name:BLACK HILLS SPECIAL SERVICES
Entity Type:Organization
Organization Name:BLACK HILLS SPECIAL SERVICES
Other - Org Name:WESTERN FS360PLANS
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPPORT COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN-CLAIRE
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:HAMBLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-394-5120
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-0218
Mailing Address - Country:US
Mailing Address - Phone:605-347-4467
Mailing Address - Fax:605-347-5223
Practice Address - Street 1:730 E WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1300
Practice Address - Country:US
Practice Address - Phone:605-394-5120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251X00000XAgenciesSupports Brokerage
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5180140Medicaid