Provider Demographics
NPI:1689612475
Name:NORTHEAST HUMAN SERVICE CENTER
Entity Type:Organization
Organization Name:NORTHEAST HUMAN SERVICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CFO - DHS
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-328-4924
Mailing Address - Street 1:151 S 4TH ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4715
Mailing Address - Country:US
Mailing Address - Phone:701-795-3000
Mailing Address - Fax:701-795-3050
Practice Address - Street 1:151 S 4TH ST
Practice Address - Street 2:SUITE 401
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4715
Practice Address - Country:US
Practice Address - Phone:701-795-3000
Practice Address - Fax:701-795-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND032317Medicaid
NDRAILROAD MEDICAREOtherRR MEDICARE GROUP ID
NDBCBS OF MNOtherBCBSMN GROUP ID
NDBCBS OF NDOtherGROUP BCBSNE ID
NDRAILROAD MEDICAREOtherRR MEDICARE GROUP ID