Provider Demographics
NPI:1316167505
Name:ROSEBUD SIOUX TRIBE PIYA MANI OTIPI
Entity type:Organization
Organization Name:ROSEBUD SIOUX TRIBE PIYA MANI OTIPI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:PARSELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-856-5530
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:SD
Mailing Address - Zip Code:57555-0428
Mailing Address - Country:US
Mailing Address - Phone:605-856-5530
Mailing Address - Fax:605-856-5527
Practice Address - Street 1:BRISTAL RANCH HWY 18
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:SD
Practice Address - Zip Code:57555-0428
Practice Address - Country:US
Practice Address - Phone:605-856-5530
Practice Address - Fax:605-856-5527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility