Provider Demographics
NPI:1225051550
Name:NORTHWEST HUMAN SERVICE CENTER
Entity Type:Organization
Organization Name:NORTHWEST HUMAN SERVICE CENTER
Other - Org Name:NWHSC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLVASLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-774-4600
Mailing Address - Street 1:PO BOX 1266
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58802-1266
Mailing Address - Country:US
Mailing Address - Phone:701-774-4600
Mailing Address - Fax:701-774-4620
Practice Address - Street 1:316 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5218
Practice Address - Country:US
Practice Address - Phone:701-774-4600
Practice Address - Fax:701-774-4620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND035201Medicaid