Provider Demographics
NPI:1306606132
Name:CHILDRENS HOME SOCIETY OF SOUTH DAKOTA
Entity type:Organization
Organization Name:CHILDRENS HOME SOCIETY OF SOUTH DAKOTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANALYST
Authorized Official - Prefix:
Authorized Official - First Name:GIBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-965-3149
Mailing Address - Street 1:PO BOX 1749
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57101-1749
Mailing Address - Country:US
Mailing Address - Phone:605-334-6004
Mailing Address - Fax:
Practice Address - Street 1:4402 E 3RD ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-6650
Practice Address - Country:US
Practice Address - Phone:605-334-6004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty