Provider Demographics
NPI:1154677896
Name:BOWLING GREEN INN OF SOUTH DAKOTA
Entity Type:Organization
Organization Name:BOWLING GREEN INN OF SOUTH DAKOTA
Other - Org Name:KEYSTONE TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:REGIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-987-2751
Mailing Address - Street 1:1010 E 2ND ST
Mailing Address - Street 2:P.O. BOX 159
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-1905
Mailing Address - Country:US
Mailing Address - Phone:605-987-2751
Mailing Address - Fax:605-987-2365
Practice Address - Street 1:1010 E 2ND ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-1905
Practice Address - Country:US
Practice Address - Phone:605-987-2751
Practice Address - Fax:605-987-2365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-31
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10504324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility