Provider Demographics
NPI:1114002573
Name:SOUTHEASTERN BEHAVIORAL HEALTHCARE
Entity Type:Organization
Organization Name:SOUTHEASTERN BEHAVIORAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-336-0510
Mailing Address - Street 1:2000 S SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2727
Mailing Address - Country:US
Mailing Address - Phone:605-336-0510
Mailing Address - Fax:
Practice Address - Street 1:2000 S SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-336-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0801X
SD261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5200020Medicaid
SD1002113OtherBLUE CROSS & BLUE SHIELD
SD=========OtherDAKOTACARE