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Organization
SISSETON WAHPETON OYATE
Active
Organization
SISSETON WAHPETON OYATE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. EDMUND JOHNSON JR. (SISSETON-WAHPETON OYATE TRIBAL SECR)
(605) 698-3911
Entity
Organization
Contact information
Practice address
12554 BIA HWY 711, AGENCY VILLAGE, SD 57262
(605) 698-3911
(605) 698-3276
Mailing address
PO BOX 509, AGENCY VILLAGE, SD 57262
(605) 698-3911
(605) 698-3276
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
—
NULL
172V00000X
Community Health Worker
—
—
251300000X
Local Education Agency (LEA)
—
NULL
252Y00000X
Early Intervention Provider Agency
—
NULL
253J00000X
Foster Care Agency
—
NULL
253Z00000X
In Home Supportive Care Agency
—
NULL
261Q00000X
Clinic/Center
Primary
—
NULL
332U00000X
Home Delivered Meals
—
NULL
347C00000X
Private Vehicle
—
NULL
Other
Enumeration date
06/20/2018
Last updated
01/04/2024
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