Organization
LIFEQUEST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARYL KILSTROM (EXECUTIVE DIRECTOR)
(605) 996-2032
Entity
Organization
Contact information
Practice address
804 N MENTZER ST, MITCHELL, SD 57301-2130
(605) 996-2032
(605) 996-0972
Mailing address
804 N MENTZER ST, MITCHELL, SD 57301-2130
(605) 996-2032
(605) 996-0972
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5180080
—
SD
Enumeration date
04/04/2007
Last updated
08/22/2020
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