Provider Demographics
NPI:1144358433
Name:SKY RANCH FOR BOYS, INC.
Entity type:Organization
Organization Name:SKY RANCH FOR BOYS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-797-4422
Mailing Address - Street 1:100 SKY RANCH LN
Mailing Address - Street 2:
Mailing Address - City:SKY RANCH
Mailing Address - State:SD
Mailing Address - Zip Code:57724-9401
Mailing Address - Country:US
Mailing Address - Phone:605-797-4422
Mailing Address - Fax:605-797-4425
Practice Address - Street 1:100 SKY RANCH LN
Practice Address - Street 2:
Practice Address - City:SKY RANCH
Practice Address - State:SD
Practice Address - Zip Code:57724-9401
Practice Address - Country:US
Practice Address - Phone:605-797-4422
Practice Address - Fax:605-797-4425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR57 97,326322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1103747Medicaid