Provider Demographics
NPI:1699402917
Name:GREAT PLAINS AREA YOUTH REGIONAL TREATMENT CENTER
Entity type:Organization
Organization Name:GREAT PLAINS AREA YOUTH REGIONAL TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BHS EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:CAMPBELL-LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-216-9317
Mailing Address - Street 1:PO BOX 680
Mailing Address - Street 2:
Mailing Address - City:MOBRIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57601-0680
Mailing Address - Country:US
Mailing Address - Phone:605-226-7341
Mailing Address - Fax:
Practice Address - Street 1:12451 HWY 1806
Practice Address - Street 2:
Practice Address - City:MOBRIDGE
Practice Address - State:SD
Practice Address - Zip Code:57601
Practice Address - Country:US
Practice Address - Phone:605-226-7341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-05
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty