Trec Badlands Prenatal to Five Head Start

Primary specialty

Health EducatorTaxonomy code 174H00000X

Legal business name

TREC BADLANDS PRENATAL TO FIVE HEAD START

Practice address

101 5TH Ave
Belle Fourche, SD 57717-1139

Phone

(605) 723-8837

Fax

(605) 723-8834

NPI assigned

Jan 5, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Douglas Jacobson, MSW,MBA

Title

Executive Director

Phone

(605) 723-8837

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1295039220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 5TH AVE",
            "city": "BELLE FOURCHE",
            "state": "SD",
            "postal_code": "577171139",
            "telephone_number": "605-723-8837",
            "fax_number": "605-723-8834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 5TH AVE",
            "city": "BELLE FOURCHE",
            "state": "SD",
            "postal_code": "577171139",
            "telephone_number": "605-723-8837",
            "fax_number": "605-723-8834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TREC BADLANDS PRENATAL TO FIVE HEAD START",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "605-723-8837",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSW,MBA"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Health Educator",
            "state": "SD",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Belle Fourche, SD
• Health Educator in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.