National Provider Identifier Database

STATE TREATMENT AND REHABILITATION ACADEMY
Substance Abuse Treatment, Children

A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of children with disorders in the use of drugs, alcohol, and other substances. Medical and supportive counseling services and education services are included.


Contact Information

STATE TREATMENT AND REHABILITATION ACADEMY
25292 BADGER CLARK RD
CUSTER, SD57730-8244
Phone: 605-255-4937
Fax:
Website:
Specialty Taxonomy Code
* Substance Abuse Treatment, Children 3245S0500X

* Indicates primary specialty

NPI Profile & details for STATE TREATMENT AND REHABILITATION ACADEMY

NPI Number 1740473115
Legal business name
LBN
STATE TREATMENT AND REHABILITATION ACADEMY
Authorized official CHARLES GILSON - (DIRECTOR)
Entity Organization
Organization subpart No
Enumeration date 08/20/2007
Last updated 08/20/2007 - About 19 years ago
Sole proprietor1 Not specified
Identifiers
  • SD Medicaid: 5160390

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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