Provider Demographics
NPI:1184352734
Name:DAKOTA FAMILY SERVICES
Entity type:Organization
Organization Name:DAKOTA FAMILY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL SERVICES MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHONDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GANTZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-857-4232
Mailing Address - Street 1:PO BOX 5007
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-5007
Mailing Address - Country:US
Mailing Address - Phone:701-857-4232
Mailing Address - Fax:701-852-1190
Practice Address - Street 1:1227 N 35TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-7722
Practice Address - Country:US
Practice Address - Phone:701-857-6508
Practice Address - Fax:701-837-9953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1460313Medicaid