Provider Demographics
NPI:1124585013
Name:CHILDREN'S CARE HOSPITAL AND SCHOOL
Entity Type:Organization
Organization Name:CHILDREN'S CARE HOSPITAL AND SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OR OUTPATIENT OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-444-9711
Mailing Address - Street 1:2501 W 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2446
Mailing Address - Country:US
Mailing Address - Phone:605-444-9500
Mailing Address - Fax:605-444-9706
Practice Address - Street 1:7220 W 41ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57106-6028
Practice Address - Country:US
Practice Address - Phone:605-444-9500
Practice Address - Fax:605-444-9706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD433300Medicaid
8CH01OtherWELLMARK BCBS