Provider Demographics
NPI:1689824146
Name:BLACK HILLS SPECIAL SERVICES COOPERATIVE
Entity Type:Organization
Organization Name:BLACK HILLS SPECIAL SERVICES COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LUSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-224-5336
Mailing Address - Street 1:730 E WATERTOWN ST
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-1300
Mailing Address - Country:US
Mailing Address - Phone:605-394-5120
Mailing Address - Fax:605-394-6083
Practice Address - Street 1:730 E WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1300
Practice Address - Country:US
Practice Address - Phone:605-394-5120
Practice Address - Fax:605-394-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty