Provider Demographics
NPI:1124096029
Name:EASTSIDE NEIGHBORHOOD CENTER, INC.
Entity type:Organization
Organization Name:EASTSIDE NEIGHBORHOOD CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ATTEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:605-224-7226
Mailing Address - Street 1:2400 E CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-3013
Mailing Address - Country:US
Mailing Address - Phone:605-224-7226
Mailing Address - Fax:605-224-7387
Practice Address - Street 1:2400 E CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501-3013
Practice Address - Country:US
Practice Address - Phone:605-224-7226
Practice Address - Fax:605-224-7387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD431828261QF0400X
SD431829261QF0400X
SD431830261QF0400X
SD431832261QF0400X
SD431831261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5350270Medicaid
SD431832Medicare ID - Type UnspecifiedTIOSPAYE TOPA
SD431829Medicare ID - Type UnspecifiedTAKINI
SD431828Medicare ID - Type UnspecifiedMAIN LOCATION-PIERRE, SD
SD431830Medicare ID - Type UnspecifiedBUCHANAN
SD5350270Medicaid