Provider Demographics
NPI:1457504649
Name:SOUTH DAKOTA ACHIEVE
Entity Type:Organization
Organization Name:SOUTH DAKOTA ACHIEVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SERVICE COORDINATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVANAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-274-1356
Mailing Address - Street 1:4100 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6620
Mailing Address - Country:US
Mailing Address - Phone:605-336-7100
Mailing Address - Fax:605-338-0259
Practice Address - Street 1:4100 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6620
Practice Address - Country:US
Practice Address - Phone:605-336-7100
Practice Address - Fax:605-338-0259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty