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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
251300000X
Local Education Agency (LEA)
252Y00000X
Early Intervention Provider Agency
253J00000X
Foster Care Agency
253Z00000X
In Home Supportive Care Agency
261Q00000X
Clinic/Center
Primary
332U00000X
Home Delivered Meals
347C00000X
Private Vehicle

Other

Enumeration date
06/20/2018
Last updated
01/04/2024
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