1720074644 NPI number — HUMAN SERVICE AGENCY

Table of content: (NPI 1720074644)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720074644 NPI number — HUMAN SERVICE AGENCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUMAN SERVICE AGENCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720074644
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1030
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATERTOWN
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57201-6030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-886-0123
Provider Business Mailing Address Fax Number:
605-886-5447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 19TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATERTOWN
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57201-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-886-0123
Provider Business Practice Location Address Fax Number:
605-886-5447
Provider Enumeration Date:
09/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SHERMAN
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
605-886-0123

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , with the licence number:  006 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: 704 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103T00000X , with the licence number: 006 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TA0400X , with the licence number: 704 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: 006 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0802X , with the licence number: 704 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 006 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0405X , with the licence number: 704 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: 006 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: 704 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 006 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X , with the licence number: 704 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5261010 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5200010 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5255010 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5001040 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5256010 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0180020 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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