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117 Knollwood Dr Rapid City SD 57701-0693 | |
| (605) 718-4870 | |
| (605) 718-4878 |
| Full Name | |
|---|---|
| Speciality | Substance Abuse Rehabilitation Facility |
| Location | 117 Knollwood Dr, Rapid City, South Dakota |
| Authorized Official Name and Position | Carla Sue Dennis (CLINICAL SUPERVISOR) |
| Authorized Official Contact | 6057184870 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1087 Rapid City SD 57709-1087 Ph: (605) 718-4870 | 117 Knollwood Dr Rapid City SD 57701-0693 Ph: (605) 718-4870 |
| NPI Number | 1891823332 |
|---|---|
| Provider Enumeration Date | 02/28/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891823332 | NPI | - | NPPES |
| 5160320 | Medicaid | SD | |
| 5005080 | Medicaid | SD | |
| 5005082 | Medicaid | SD | |
| 7100744 | Medicaid | SD |
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