Provider Demographics
NPI:1811017155
Name:CHILDRENS HOME SOCIETY OF SOUTH DAKOTA
Entity Type:Organization
Organization Name:CHILDRENS HOME SOCIETY OF SOUTH DAKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BILL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-334-6004
Mailing Address - Street 1:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57101-1749
Mailing Address - Country:US
Mailing Address - Phone:605-334-6004
Mailing Address - Fax:605-335-2776
Practice Address - Street 1:801 N SYCAMORE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57110-5746
Practice Address - Country:US
Practice Address - Phone:605-334-6004
Practice Address - Fax:605-335-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR51322D00000X
SDR45323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5169030Medicaid
SD5169010Medicaid
SD117063500Medicaid
SD5169020Medicaid