Provider Demographics
NPI:1407021579
Name:HUMAN DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:HUMAN DEVELOPMENT CENTER
Other - Org Name:HUMAN DEVELOPMENT CENTER
Other - Org Type:Doing Business As
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 E 1ST ST
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:218-728-4404
Practice Address - Street 1:1500 N 34TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-4476
Practice Address - Country:US
Practice Address - Phone:715-392-8216
Practice Address - Fax:715-395-6055
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HUMAN DEVELOPMENT CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42252300Medicaid
WI000018031Medicare PIN