Organization
STAR ACADEMY FOR YOUTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF BATHKE (PROGRAM ADMINISTRATOR)
(605) 773-3123
Entity
Organization
Contact information
Practice address
12279 BRADY DR, CUSTER, SD 57730-9160
(605) 673-2521
(605) 673-4654
Mailing address
12279 BRADY DR, CUSTER, SD 57730-9160
(605) 673-2521
(605) 673-4654
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5000360
SD
Other
Enumeration date
05/14/2009
Last updated
05/14/2009
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