1104253020 NPI number — NORTHERN PLAINS CHILDREN'S ADVOCACY CENTER

Table of content: (NPI 1104253020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104253020 NPI number — NORTHERN PLAINS CHILDREN'S ADVOCACY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN PLAINS CHILDREN'S ADVOCACY CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104253020
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MINOT
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58702-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-858-2083
Provider Business Mailing Address Fax Number:
701-852-0623

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 1ST ST SW STE 202
Provider Second Line Business Practice Location Address:
NORTHERN PLAINS CHILDREN'S ADVOCACY CENTER
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58701-3851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-852-0836
Provider Business Practice Location Address Fax Number:
701-852-0623
Provider Enumeration Date:
10/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
LEMAY
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
J
Authorized Official Title or Position:
NPCAC DIRECTOR
Authorized Official Telephone Number:
701-852-0836

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  2198 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 251S00000X , with the licence number: 3960 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1760571285 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 19261 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1245329812 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 19238 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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