Provider Demographics
NPI:1184785222
Name:PLANKINTON SCHOOL DISTRICT 1 1
Entity type:Organization
Organization Name:PLANKINTON SCHOOL DISTRICT 1 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:EAST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-942-7743
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:PLANKINTON SCHOOL DISTRICT 1 1
Mailing Address - City:PLANKINTON
Mailing Address - State:SD
Mailing Address - Zip Code:57368-0190
Mailing Address - Country:US
Mailing Address - Phone:605-942-7743
Mailing Address - Fax:605-942-7453
Practice Address - Street 1:404 EAST DAVENPORT
Practice Address - Street 2:PLANKINTON SCHOOL DISTRICT 1 1
Practice Address - City:PLANKINTON
Practice Address - State:SD
Practice Address - Zip Code:57368-0190
Practice Address - Country:US
Practice Address - Phone:605-942-7743
Practice Address - Fax:605-942-7453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5150240Medicaid