Provider Demographics
NPI:1801964952
Name:NORTHEASTERN SOUTH DAKOTA MENTAL HEALTH CENTER
Entity type:Organization
Organization Name:NORTHEASTERN SOUTH DAKOTA MENTAL HEALTH CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-225-1010
Mailing Address - Street 1:14 S MAIN ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4136
Mailing Address - Country:US
Mailing Address - Phone:605-225-1010
Mailing Address - Fax:605-225-1017
Practice Address - Street 1:14 S MAIN ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4136
Practice Address - Country:US
Practice Address - Phone:605-225-1010
Practice Address - Fax:605-225-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5255030Medicaid
SD5261030Medicaid
SD0000108OtherBCBS WELLMARK
SD5256030Medicaid
SDCP7629OtherRAILROAD MEDICARE
SD9236729OtherDAKOTACARE
SD5200030Medicaid
SD108Medicare PIN