Provider Demographics
NPI:1225208010
Name:ROSEBUD SIOUX TRIBE ALCOHOL DRUG TREATMENT PROGRAM
Entity Type:Organization
Organization Name:ROSEBUD SIOUX TRIBE ALCOHOL DRUG TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:EAGLE BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:605-747-2342
Mailing Address - Street 1:# 7 HOSPITAL LANE
Mailing Address - Street 2:PO BOX 348
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0348
Mailing Address - Country:US
Mailing Address - Phone:605-747-2342
Mailing Address - Fax:605-747-2111
Practice Address - Street 1:# 7 HOSPITAL LANE
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570-0348
Practice Address - Country:US
Practice Address - Phone:605-747-2342
Practice Address - Fax:605-747-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility