Healthcare Provider Details

I. General information

NPI: 1265660187
Provider Name (Legal Business Name): WEST CENTRAL HUMAN SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 BIRCHWOOD DR
BISMARCK ND
58504-6209
US

IV. Provider business mailing address

1237 W DIVIDE AVE STE 5
BISMARCK ND
58501-1208
US

V. Phone/Fax

Practice location:
  • Phone: 701-425-3930
  • Fax:
Mailing address:
  • Phone: 701-628-8888
  • Fax: 701-628-8900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number1018
License Number StateND

VIII. Authorized Official

Name: DONNA AUKLAND
Title or Position: ASSISTANT CFO - DHS
Credential:
Phone: 701-328-4924