Provider Demographics
NPI:1376663468
Name:HUMAN DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:HUMAN DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HATFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-728-4491
Mailing Address - Street 1:1401 EAST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2407
Mailing Address - Country:US
Mailing Address - Phone:218-728-4491
Mailing Address - Fax:218-730-2367
Practice Address - Street 1:325 11TH AVE
Practice Address - Street 2:
Practice Address - City:TWO HARBORS
Practice Address - State:MN
Practice Address - Zip Code:55616-1300
Practice Address - Country:US
Practice Address - Phone:218-834-5520
Practice Address - Fax:218-834-4264
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMAN DEVELOPMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-30
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
MN8534482251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN744755800Medicaid
MN946317800Medicaid
MNC08205Medicare ID - Type UnspecifiedLAKE COUNTY
MNC08205Medicare PIN