Provider Demographics
NPI:1184277626
Name:HUBBARD COUNTY DEVELOPMENTAL ACHIEVEMENT CENTER
Entity type:Organization
Organization Name:HUBBARD COUNTY DEVELOPMENTAL ACHIEVEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-237-8518
Mailing Address - Street 1:PO BOX 86
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56470-0086
Mailing Address - Country:US
Mailing Address - Phone:218-237-8518
Mailing Address - Fax:218-237-8519
Practice Address - Street 1:1009 HOLLINGER ST
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56470-1300
Practice Address - Country:US
Practice Address - Phone:218-366-3031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care