Provider Demographics
NPI:1275615783
Name:HOT SPRINGS VETERANS ADMINISTRATION
Entity Type:Organization
Organization Name:HOT SPRINGS VETERANS ADMINISTRATION
Other - Org Name:VA HOT SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADDICTION THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:TALBERT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:605-745-2000
Mailing Address - Street 1:12619 HOT BROOK CANYON RD
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57747-7501
Mailing Address - Country:US
Mailing Address - Phone:605-745-5121
Mailing Address - Fax:
Practice Address - Street 1:500 NORTH FIFTH ST
Practice Address - Street 2:VA HOT SPRINGS
Practice Address - City:HOT SPRINGS
Practice Address - State:SD
Practice Address - Zip Code:57747
Practice Address - Country:US
Practice Address - Phone:605-745-2000
Practice Address - Fax:605-745-2089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT665324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility