Provider Demographics
NPI:1003411745
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:ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-965-3149
Mailing Address - Street 1:801 N SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57110-5746
Mailing Address - Country:US
Mailing Address - Phone:605-334-6004
Mailing Address - Fax:605-335-2776
Practice Address - Street 1:5301 US-16 WEST
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-8700
Practice Address - Country:US
Practice Address - Phone:605-393-4278
Practice Address - Fax:605-341-7437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOME SOCIETY OF SOUTH DAKOTA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-01
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty