Provider Demographics
NPI:1740326214
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 COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARLYS
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-578-3298
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:605-578-3298
Mailing Address - Fax:605-722-2603
Practice Address - Street 1:870 MAIN ST
Practice Address - Street 2:
Practice Address - City:DEADWOOD
Practice Address - State:SD
Practice Address - Zip Code:57732-1004
Practice Address - Country:US
Practice Address - Phone:605-578-3298
Practice Address - Fax:605-722-2603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5180052Medicaid