1902940182 NPI number — DAKOTA FAMILY SERVICES, INC

Table of content: (NPI 1902940182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902940182 NPI number — DAKOTA FAMILY SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAKOTA FAMILY 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:
6
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:
1902940182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1148
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:
58702-1148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-837-6508
Provider Business Mailing Address Fax Number:
701-858-1839

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 45TH ST SW
Provider Second Line Business Practice Location Address:
SUITE 311
Provider Business Practice Location Address City Name:
FARGO
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58103-1189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-837-6508
Provider Business Practice Location Address Fax Number:
701-858-1839
Provider Enumeration Date:
02/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IREY
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
F
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
701-837-6508

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 13661 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 06641001 . This is a "BLUE CROSS BLUE SHIELD ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
  • Identifier: 06641002 . This is a "BCBS OF ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".




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