Great Plains Area Youth Regional Treatment Center

Primary specialty

Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X

Legal business name

GREAT PLAINS AREA YOUTH REGIONAL TREATMENT CENTER

Doing business as

IHS Great Plains Area Behavioral Health Services

Practice address

12451 Hwy 1806 N
Mobridge, SD 57601-5760

Phone

(605) 845-7181

Fax

(605) 845-5072

NPI assigned

May 12, 2022

Last updated

Aug 4, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lavon Booth

Title

Program Director

Phone

(605) 845-7181

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• IHS Great Plains Area Behavioral Health Services Doing business as

Electronic endpoints 1

Tax ID family

Great Plains Area Youth Regional Treatment Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Great Plains Area Youth Regional Treatment Center

  • Community/Behavioral Health Agency
  • Mobridge, SD
  • NPI 1699402917
  NPD tax ID

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

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659571200000",
    "number": "1316683204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 680",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576010680",
            "telephone_number": "605-850-8249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12451 HWY 1806 N",
            "city": "MOBRIDGE",
            "state": "SD",
            "postal_code": "576015760",
            "telephone_number": "605-845-7181",
            "fax_number": "605-845-5072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT PLAINS AREA YOUTH REGIONAL TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-12",
        "last_updated": "2022-08-04",
        "certification_date": "2022-08-04",
        "status": "A",
        "authorized_official_last_name": "BOOTH",
        "authorized_official_first_name": "LAVON",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR",
        "authorized_official_telephone_number": "605-845-7181"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2022304",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5095050",
            "state": "SD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "Mobridge",
            "affiliation": "N",
            "address_1": "12451 Hwy 1806 N",
            "city": "Mobridge",
            "state": "SD",
            "country_code": "US",
            "postal_code": "57601",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "IHS Great Plains Area Behavioral Health Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Family Pharmacy of Mobridge Inc (Family Pharmacy-Clinic)
• Mary Sue Fonkert, M.S.W., L.C.S.W.
• Karen Fryhling
• Ashley Dawn Geist, LPC-20667-SUPV
• Candida Goehring, C NP
• Great Plains Area Youth Regional Treatment Center
• Great Plains Area Youth Regional Treatment Center
• Jessica Lynne Haefner, M.S. LPC-MH, LPCC
• Jackie Lynn Hanna
• Kim Marie Hannan, OTR/L

• Mental Illness Community Based Residential Treatment Facility in Mobridge, SD
• Providers in Mobridge, SD by specialty
• Mental Illness Community Based Residential Treatment Facility in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 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.