NPIMap

Organization Active NPI

State Treatment and Rehabilitation Academy

  • Children's Substance Abuse Rehabilitation Facility
  • Custer, SD
National Provider Identifier
1205028131
Registry record updated Aug 14, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's Substance Abuse Rehabilitation FacilityTaxonomy code 3245S0500X
Legal business name
STATE TREATMENT AND REHABILITATION ACADEMY
Practice address
25298 Badger Clark Rd
Custer, SD 57730-8244
Phone
(605) 673-4835
NPI assigned
Aug 14, 2007
Organization subpart
Yes
Parent organization
SOUTH DAKOTA DEPARTMENT OF CORRECTIONSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 14, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charles Gilson
Title
Director
Phone
(605) 673-2521

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Substance Abuse Rehabilitation Facility 3245S0500X Primary

Addresses

Primary practice location

25298 Badger Clark Rd
Custer, SD 57730-8244

Mailing address

12279 Brady Dr
Custer, SD 57730-9160

Other identifiers 1

IdentifierTypeStateIssuer
5160280MedicaidSD

National Provider Directory

National Provider Directory
Tax ID family
SD Dept of HLTH Dba CHI35 organizations share this tax ID, including this one
Part of
SD Dept of HLTH Dba CHI

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187049600000",
    "number": "1205028131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12279 BRADY DR",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577309160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25298 BADGER CLARK RD",
            "city": "CUSTER",
            "state": "SD",
            "postal_code": "577308244",
            "telephone_number": "605-673-4835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE TREATMENT AND REHABILITATION ACADEMY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH DAKOTA DEPARTMENT OF CORRECTIONS",
        "enumeration_date": "2007-08-14",
        "last_updated": "2007-08-14",
        "status": "A",
        "authorized_official_last_name": "GILSON",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "605-673-2521"
    },
    "taxonomies": [
        {
            "code": "3245S0500X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility, Substance Abuse Treatment, Children",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5160280",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Custer, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.