Provider Demographics
NPI:1336273432
Name:NORTH DAKOTA STATE HOSPITAL
Entity Type:Organization
Organization Name:NORTH DAKOTA STATE HOSPITAL
Other - Org Name:TRANSITIONAL LIVING
Other - Org Type:Doing Business As
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 1:2605 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-6905
Mailing Address - Country:US
Mailing Address - Phone:701-253-3650
Mailing Address - Fax:701-253-3999
Practice Address - Street 1:2207 2211 COTTAGE LANE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-253-3650
Practice Address - Fax:701-253-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5060A323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND50383Medicaid