1790857860 NPI number — CATHOLIC FAMILY SERVICES

Table of content: (NPI 1790857860)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790857860 NPI number — CATHOLIC FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CATHOLIC FAMILY SERVICES
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:
1790857860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
523 N DULUTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57104-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-988-3775
Provider Business Mailing Address Fax Number:
605-988-3747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 2ND AVE SE
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:
57201-3621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-988-3775
Provider Business Practice Location Address Fax Number:
605-988-3747
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
DOROTHY
Authorized Official Middle Name:
EILEEN
Authorized Official Title or Position:
FINANCE MANAGER
Authorized Official Telephone Number:
605-988-3775

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LPC MH 2087 , 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: 20202 . This is a "SIOUX VALLEY HEALTH PLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 6575620 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 46045 . This is a "AVERA HEALTH PLAN" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 9173854 . This is a "DAKOTA CARE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 11350 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
  • Identifier: 4997066 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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