Provider Demographics
NPI:1609025907
Name:CITY OF SIOUX FALLS
Entity Type:Organization
Organization Name:CITY OF SIOUX FALLS
Other - Org Name:FCH SCHOOL BASED HEALTH SERVICES/HAWTHORNE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:605-367-8761
Mailing Address - Street 1:521 N MAIN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57104-5948
Mailing Address - Country:US
Mailing Address - Phone:605-367-8793
Mailing Address - Fax:605-367-8247
Practice Address - Street 1:601 N SPRING AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-2721
Practice Address - Country:US
Practice Address - Phone:605-367-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
431843OtherMEDICARE FQHC
SD5350310Medicaid