43D0980898 CLIA NUMBER - BLACK HILLS FAMILY PRACTICE

Laboratory Demographics

CLIA Number: 43D0980898

Facility Name: BLACK HILLS FAMILY PRACTICE

Facility Address:
1010 BALL PARK ROAD SUITE 3
STURGIS, SD
ZIP 57785
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Facility Phone Number: 605 720-4520

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1629235627

Taxonomy: 324500000X - Substance Abuse Rehabilitation Facility
A facility or distinct part of a facility that provides a 24 hr therapeutically planned living and rehabilitative intervention environment for the treatment of individuals with disorders in the abuse of drugs, alcohol, and other substances.

CLIA Record

Field Name	Field Value
CLIA Number	43D0980898
LAB Type	Practitioner Other
Facility Name	BLACK HILLS FAMILY PRACTICE
Street	1010 BALL PARK ROAD SUITE 3
City	STURGIS
State	SD
ZIP	57785
Phone	605 720-4520
CertificateType	4
CertificateEffectiveDate	9/20/2022
CertificateExpirationDate	9/19/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024