Provider Demographics
NPI:1104379205
Name:STURGIS NUTRITION PROGRAM
Entity Type:Organization
Organization Name:STURGIS NUTRITION PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROCKY
Authorized Official - Middle Name:
Authorized Official - Last Name:RARDON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:605-342-6668
Mailing Address - Street 1:2015 TUMBLE WEED TRL
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-8810
Mailing Address - Country:US
Mailing Address - Phone:605-642-6668
Mailing Address - Fax:
Practice Address - Street 1:2015 TUMBLE WEED TRL
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-8810
Practice Address - Country:US
Practice Address - Phone:605-642-6668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST RIVER TRANSIT AUTHORITY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD12803549OtherPROVIDER NO.