Provider Demographics
NPI:1073867420
Name:ROSEBUD SIOUX TRIBE -CHR
Entity type:Organization
Organization Name:ROSEBUD SIOUX TRIBE -CHR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:605-747-5100
Mailing Address - Street 1:PO BOX 808
Mailing Address - Street 2:
Mailing Address - City:ROSEBUD
Mailing Address - State:SD
Mailing Address - Zip Code:57570-0808
Mailing Address - Country:US
Mailing Address - Phone:605-747-2316
Mailing Address - Fax:605-747-5816
Practice Address - Street 1:729 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:ROSEBUD
Practice Address - State:SD
Practice Address - Zip Code:57570
Practice Address - Country:US
Practice Address - Phone:605-747-2316
Practice Address - Fax:605-747-5816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD67347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD1970640000Medicaid