Basic Information
| Provider Information | |||||||||
| NPI: | 1356398275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEST CENTRAL HUMAN SERVICE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1237 W DIVIDE AVE | ||||||||
| Address2: | STE 5 | ||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585011208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013288888 | ||||||||
| FaxNumber: | 7013288900 | ||||||||
| Practice Location | |||||||||
| Address1: | 1237 W DIVIDE AVE | ||||||||
| Address2: | STE 5 | ||||||||
| City: | BISMARCK | ||||||||
| State: | ND | ||||||||
| PostalCode: | 585011208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013288888 | ||||||||
| FaxNumber: | 7013288900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2006 | ||||||||
| LastUpdateDate: | 12/10/2020 | ||||||||
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| AuthorizedOfficialLastName: | AUKLAND | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ASSISTANT CFO - DHS | ||||||||
| AuthorizedOfficialTelephone: | 7013284924 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 12/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD1600X | Y | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities |
ID Information
| ID | Type | State | Issuer | Description | 032320 | 05 | ND | MEDICAID |