Provider Demographics
NPI:1649316407
Name:BLACK HILLS SPECIAL SERVICES
Entity type:Organization
Organization Name:BLACK HILLS SPECIAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY SUPPORT COORDINATORS
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:ISRAELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-720-1954
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:605-720-1954
Mailing Address - Fax:605-720-1955
Practice Address - Street 1:1343 PINE ST
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:SD
Practice Address - Zip Code:57785-1914
Practice Address - Country:US
Practice Address - Phone:605-720-1954
Practice Address - Fax:605-720-1955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5180054Medicaid