Provider Demographics
NPI:1356503668
Name:SACRED HEART CENTER
Entity Type:Organization
Organization Name:SACRED HEART CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OUTREACH SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-964-6062
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:121 LANDMARK AVENUE
Mailing Address - City:EAGLE BUTTE
Mailing Address - State:SD
Mailing Address - Zip Code:57625-2000
Mailing Address - Country:US
Mailing Address - Phone:605-964-6062
Mailing Address - Fax:605-964-6060
Practice Address - Street 1:121 LANDMARK AVENUE
Practice Address - Street 2:
Practice Address - City:EAGLE BUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625-2000
Practice Address - Country:US
Practice Address - Phone:605-964-6062
Practice Address - Fax:605-964-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR86251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management