1376501262 NPI number — DAKOTA BOYS & GIRLS RANCH ASSOCIATION

Table of content: (NPI 1376501262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376501262 NPI number — DAKOTA BOYS & GIRLS RANCH ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAKOTA BOYS & GIRLS RANCH ASSOCIATION
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:
1376501262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 5007
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:
58702-5007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-839-7888
Provider Business Mailing Address Fax Number:
701-852-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 19TH AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MINOT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58703-8824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-839-7888
Provider Business Practice Location Address Fax Number:
701-852-1190
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GANTZER
Authorized Official First Name:
SHONDELL
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BOOKKEEPER
Authorized Official Telephone Number:
701-858-0115

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10348 . This is a "FARGO RTC" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 52146 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3913 . This is a "DAKOTA BOYS RANCH" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 54725 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12344 . This is a "WESTERN PLAINS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 18078 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50521 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54715 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54730 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57550 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54710 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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