Provider Demographics
NPI:1861626780
Name:DAKOTA MILESTONES
Entity Type:Organization
Organization Name:DAKOTA MILESTONES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ODENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-734-5542
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:CHAMBERLAIN
Mailing Address - State:SD
Mailing Address - Zip Code:57325-0248
Mailing Address - Country:US
Mailing Address - Phone:605-734-5542
Mailing Address - Fax:605-734-4260
Practice Address - Street 1:117 E BEEBE AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERLAIN
Practice Address - State:SD
Practice Address - Zip Code:57325-1301
Practice Address - Country:US
Practice Address - Phone:605-734-5542
Practice Address - Fax:605-734-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5180160Medicaid
SD9515110Medicaid
SD0180060Medicaid