Healthcare Provider Details

I. General information

NPI: 1124069331
Provider Name (Legal Business Name): LAKE REGION HUMAN SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HIGHWAY 2 W
DEVILS LAKE ND
58301-3532
US

IV. Provider business mailing address

200 HWY 2 W
DEVILS LAKE ND
58301-3532
US

V. Phone/Fax

Practice location:
  • Phone: 701-665-2200
  • Fax: 701-665-2300
Mailing address:
  • Phone: 701-665-2200
  • Fax: 701-665-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

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