Provider Demographics
NPI:1306398011
Name:BOWLING GREEN INN OF SOUTH DAKOTA
Entity Type:Organization
Organization Name:BOWLING GREEN INN OF SOUTH DAKOTA
Other - Org Name:KEYSTONE TREATENT 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:A
Authorized Official - Last Name:REGIER
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LAC
Authorized Official - Phone:605-987-2751
Mailing Address - Street 1:3800 S KIWANIS AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-4234
Mailing Address - Country:US
Mailing Address - Phone:605-335-1820
Mailing Address - Fax:605-335-1820
Practice Address - Street 1:3800 S KIWANIS AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-4234
Practice Address - Country:US
Practice Address - Phone:605-335-1820
Practice Address - Fax:605-335-1820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOWLING GREEN INN OF SOUTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD10504324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility