Provider Demographics
NPI:1194851469
Name:PENNINGTON COUNTY SHERIFF'S OFFICE
Entity Type:Organization
Organization Name:PENNINGTON COUNTY SHERIFF'S OFFICE
Other - Org Name:CITY COUNTY ALCOHOL AND DRUG PROGRAMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOETEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-394-6128
Mailing Address - Street 1:725 N LACROSSE ST
Mailing Address - Street 2:STE 300
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1491
Mailing Address - Country:US
Mailing Address - Phone:605-394-6128
Mailing Address - Fax:605-394-6890
Practice Address - Street 1:725 N LACROSSE ST
Practice Address - Street 2:STE 300
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1491
Practice Address - Country:US
Practice Address - Phone:605-394-6128
Practice Address - Fax:605-394-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility