Provider Demographics
NPI:1043350440
Name:SOUTHERN PLAINS BEHAVIORAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:SOUTHERN PLAINS BEHAVIORAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:FORTUNA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:605-842-1465
Mailing Address - Street 1:500 E 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580
Mailing Address - Country:US
Mailing Address - Phone:605-842-1465
Mailing Address - Fax:605-842-2366
Practice Address - Street 1:500 E 9TH STREET
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580
Practice Address - Country:US
Practice Address - Phone:605-842-1465
Practice Address - Fax:605-842-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200120Medicaid
SD5256120Medicaid
SD0069989OtherBLUE CROSS BLUE SHIELD
SD9176024OtherDAKOTA CARE
SD5200120Medicaid
SD5200120Medicaid
SD5261120Medicaid