Organization
STATE TREATMENT AND REHABILITATION ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES GILSON (DIRECTOR)
(605) 673-2521
Entity
Organization
Contact information
Practice address
25292 BADGER CLARK RD, CUSTER, SD 57730-8244
(605) 255-4937
Mailing address
12279 BRADY DR, CUSTER, SD 57730-9160
Taxonomy
Speciality
Code
Description
License number
State
3245S0500X
Children's Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5160390
—
SD
Enumeration date
08/20/2007
Last updated
08/20/2007
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