Provider Demographics
NPI:1871639625
Name:BLACK HILLS SPECIAL SERVICES
Entity Type:Organization
Organization Name:BLACK HILLS SPECIAL SERVICES
Other - Org Name:CENTRAL SD FAMILY SUPPORT
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-347-4467
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:SD
Mailing Address - Zip Code:57785-0218
Mailing Address - Country:US
Mailing Address - Phone:605-845-2286
Mailing Address - Fax:605-845-7062
Practice Address - Street 1:221 S CENTRAL AVE STE 33
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-2453
Practice Address - Country:US
Practice Address - Phone:605-224-6287
Practice Address - Fax:605-224-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5180053Medicaid