Healthcare Provider Details

I. General information

NPI: 1558427708
Provider Name (Legal Business Name): LIFE SKILLS AND TRANSITION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W 6TH ST
GRAFTON ND
58237-1379
US

IV. Provider business mailing address

701 W 6TH ST
GRAFTON ND
58237-1379
US

V. Phone/Fax

Practice location:
  • Phone: 701-352-4564
  • Fax: 701-352-4376
Mailing address:
  • Phone: 701-352-4564
  • Fax: 701-352-4376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

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