Provider Demographics
NPI:1689185860
Name:ADULT DAY CENTER OF THE BLACK HILLS
Entity Type:Organization
Organization Name:ADULT DAY CENTER OF THE BLACK HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-791-0436
Mailing Address - Street 1:4110 WINFIELD CT
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-8306
Mailing Address - Country:US
Mailing Address - Phone:605-791-0436
Mailing Address - Fax:605-791-1106
Practice Address - Street 1:4110 WINFIELD ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8306
Practice Address - Country:US
Practice Address - Phone:605-791-0436
Practice Address - Fax:605-791-1106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-16
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDDL137092OtherSOUTH DAKOTA SECRETARY OF STATE
SDDL137092OtherSOUTH DAKOTA SECRETARY OF STATE