1144358433 NPI number — SKY RANCH FOR BOYS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144358433 NPI number — SKY RANCH FOR BOYS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SKY RANCH FOR BOYS, INC.
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:
1144358433
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 SKY RANCH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKY RANCH
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57724-9401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-797-4422
Provider Business Mailing Address Fax Number:
605-797-4425

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 SKY RANCH LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SKY RANCH
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57724-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-797-4422
Provider Business Practice Location Address Fax Number:
605-797-4425
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOUKS
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
605-797-4422

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  R57 97,326 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1103747 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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