1720293301 NPI number — CHARLES HALL YOUTH SERVICES INC.

Table of content: (NPI 1720293301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720293301 NPI number — CHARLES HALL YOUTH SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES HALL YOUTH SERVICES 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:
1720293301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 E BISMARCK EXPY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BISMARCK
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58504-6577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-255-2773
Provider Business Mailing Address Fax Number:
701-255-6261

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 E BISMARCK EXPY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BISMARCK
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58504-6577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-255-2773
Provider Business Practice Location Address Fax Number:
701-255-6261
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLOPP
Authorized Official First Name:
GAYLE
Authorized Official Middle Name:
ROBERT
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
701-255-2773

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 27505 . This is a "LAVONNA FUCHS - BCBS PIN" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27506 . This is a "KATHRYN KRUKENBERG TRIWES" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 19167 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27506 . This is a "KATHRYN KRUKENBERG BCBS" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27507 . This is a "AMY FAST TRIWEST PIN" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27505 . This is a "TRIWEST PIN" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 27507 . This is a "AMY FAST BCBS PIN" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 74005 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74006 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74003 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50602 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74004 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com