1407949167 NPI number — THE HILLS YOUTH AND FAMILY SERVICES

Table of content: (NPI 1407949167)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407949167 NPI number — THE HILLS YOUTH AND FAMILY SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE HILLS YOUTH AND FAMILY SERVICES
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:
CAMBIA HILLS
Provider Other Organization Name Type Code:
3
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:
1407949167
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4321 ALLENDALE AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55803-1562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-728-7500
Provider Business Mailing Address Fax Number:
218-728-7501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4321 ALLENDALE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-728-7500
Provider Business Practice Location Address Fax Number:
218-728-7408
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEROLD
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
218-623-6425

Provider Taxonomy Codes

  • Taxonomy code: 261QM0855X , with the licence number:  040978200 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 322D00000X , with the licence number: 1036983-1-CRF , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 262L1WO . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 136305 . This is a "UCARE MINNESOTA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 8467273 . This is a "UBH/MEDICA SELECT CARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 040978200 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1042152 . This is a "PREFERREDONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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