Provider Demographics
NPI:1639130917
Name:DAKOTA FAMILY SERVICES, INC
Entity Type:Organization
Organization Name:DAKOTA FAMILY SERVICES, INC
Other - Org Name:DAKOTA FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHONDELL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GANTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-858-0115
Mailing Address - Street 1:PO BOX 1148
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-1148
Mailing Address - Country:US
Mailing Address - Phone:701-858-0115
Mailing Address - Fax:701-852-1190
Practice Address - Street 1:600 22ND AVE NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-0986
Practice Address - Country:US
Practice Address - Phone:701-837-6508
Practice Address - Fax:701-858-1839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND06641001OtherBLUE CROSS BLUE SHIELD ND
ND13527Medicaid
ND06641001OtherBLUE CROSS BLUE SHIELD ND
ND13527Medicaid