Provider Demographics
NPI:1518039627
Name:GREAT PLAINS AREA YOUTH REGIONAL TREATMENT CENTER
Entity Type:Organization
Organization Name:GREAT PLAINS AREA YOUTH REGIONAL TREATMENT CENTER
Other - Org Name:AAYRTC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL SUPPORT ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-845-7181
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:12451 HIGHWAY 1806
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-0680
Mailing Address - Country:US
Mailing Address - Phone:605-845-7181
Mailing Address - Fax:605-845-5072
Practice Address - Street 1:12451 HIGHWAY 1806
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601-0680
Practice Address - Country:US
Practice Address - Phone:605-845-7181
Practice Address - Fax:605-845-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5095050Medicaid
SD807OtherDHS ACCREDITATION
76292OtherCARF ACCREDITATION