1093114233 NPI number — SOUTH CENTRAL ADULT SERVICES COUNCIL INC.

Table of content: (NPI 1093114233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093114233 NPI number — SOUTH CENTRAL ADULT SERVICES COUNCIL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH CENTRAL ADULT SERVICES COUNCIL INC.
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:
1093114233
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 298
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALLEY CITY
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58072-0298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-845-4300
Provider Business Mailing Address Fax Number:
701-845-4073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
139 2ND AVE. SE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY CITY
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-845-4300
Provider Business Practice Location Address Fax Number:
701-845-4073
Provider Enumeration Date:
08/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
HANSEN
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
701-845-4300

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1463718 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 57907 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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