Provider Demographics
NPI:1407068778
Name:LAKE REGION FAMILY PLANNING PROGRAM
Entity Type:Organization
Organization Name:LAKE REGION FAMILY PLANNING PROGRAM
Other - Org Name:LAKE REGION DISTRICT HEALTH UNIT
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HALLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-662-7046
Mailing Address - Street 1:524 4TH AVE NE UNIT 9
Mailing Address - Street 2:RAMSEY COUNTY COURTHOUSE
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2490
Mailing Address - Country:US
Mailing Address - Phone:701-662-7046
Mailing Address - Fax:701-662-7073
Practice Address - Street 1:524 4TH AVE NE UNIT 9
Practice Address - Street 2:RAMSEY COUNTY COURTHOUSE
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2490
Practice Address - Country:US
Practice Address - Phone:701-662-7046
Practice Address - Fax:701-662-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND53580Medicaid