Provider Demographics
NPI:1891352134
Name:SINTE GLESKA UNIVERSITY
Entity Type:Organization
Organization Name:SINTE GLESKA UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLACK BEAR
Authorized Official - Suffix:
Authorized Official - Credentials:BA-HUMAN SERVICES
Authorized Official - Phone:605-856-8291
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:ANTELOPE LAKE CAMPUS
Mailing Address - City:MISSION
Mailing Address - State:SD
Mailing Address - Zip Code:57555
Mailing Address - Country:US
Mailing Address - Phone:605-856-8291
Mailing Address - Fax:605-856-2132
Practice Address - Street 1:ANTELOPE LAKE DRIVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:SD
Practice Address - Zip Code:57555
Practice Address - Country:US
Practice Address - Phone:605-856-8291
Practice Address - Fax:605-856-2132
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SINTE GLESKA UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
46-0312209OtherCHILDRENS MENTAL HEALTH PROGRAM