Provider Demographics
NPI:1548219108
Name:TIMBERLINE TREATMENT CENTER
Entity Type:Organization
Organization Name:TIMBERLINE TREATMENT CENTER
Other - Org Name:BLACK HILLS SPECIAL SERVICES COOP
Other - Org Type:Other Name
Authorized Official - Title/Position:PROGRAM MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CCDCIII
Authorized Official - Phone:605-722-3501
Mailing Address - Street 1:2910 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-3224
Mailing Address - Country:US
Mailing Address - Phone:605-722-3501
Mailing Address - Fax:605-722-3504
Practice Address - Street 1:2910 4TH AVE
Practice Address - Street 2:
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-3224
Practice Address - Country:US
Practice Address - Phone:605-722-3501
Practice Address - Fax:605-722-3504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD613324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility