Healthcare Provider Details

I. General information

NPI: 1639876105
Provider Name (Legal Business Name): CENTRAL REGIONAL EDUCATION ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2023
Last Update Date: 08/06/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 N WASHINGTON ST STE A
BISMARCK ND
58501-1690
US

IV. Provider business mailing address

1929 N WASHINGTON ST STE A
BISMARCK ND
58501-1690
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-4041
  • Fax:
Mailing address:
  • Phone: 701-751-4041
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: LUKE SCHAEFER
Title or Position: CEO
Credential:
Phone: 701-751-4041