| Star Academy For Youth | |
|
12279 Brady Dr Custer SD 57730-9160 | |
| (605) 673-2521 | |
| (605) 673-4654 |
| Full Name | Star Academy For Youth |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 12279 Brady Dr, Custer, South Dakota |
| Authorized Official Name and Position | Jeff Bathke (PROGRAM ADMINISTRATOR) |
| Authorized Official Contact | 6057733123 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Star Academy For Youth 12279 Brady Dr Custer SD 57730-9160 Ph: (605) 673-2521 | Star Academy For Youth 12279 Brady Dr Custer SD 57730-9160 Ph: (605) 673-2521 |
| NPI Number | 1831323195 |
|---|---|
| Provider Enumeration Date | 05/14/2009 |
| Last Update Date | 05/14/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831323195 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 5000360 (South Dakota) | Primary |
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