Provider Demographics
NPI:1225209711
Name:PIERRE INDIAN LEARNING CENTER
Entity Type:Organization
Organization Name:PIERRE INDIAN LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:JEANOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-224-8661
Mailing Address - Street 1:3001 E SULLY AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-4403
Mailing Address - Country:US
Mailing Address - Phone:605-224-8861
Mailing Address - Fax:605-224-0985
Practice Address - Street 1:3001 E SULLY AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-4403
Practice Address - Country:US
Practice Address - Phone:605-224-8861
Practice Address - Fax:605-224-0985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5153010Medicaid