Provider Demographics
NPI:1629235627
Name:BLACK HILLS RECOVERY CENTER
Entity Type:Organization
Organization Name:BLACK HILLS RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD-FOSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-347-3003
Mailing Address - Street 1:1807 WILLIAMS ST
Mailing Address - Street 2:PO BOX 277
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-1142
Mailing Address - Country:US
Mailing Address - Phone:605-347-3003
Mailing Address - Fax:605-347-4944
Practice Address - Street 1:1807 WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1142
Practice Address - Country:US
Practice Address - Phone:605-347-3003
Practice Address - Fax:605-347-4944
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHERN HILLS ALCOHOL AND DRUG SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-19
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDACCREDITATION324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility