Healthcare Provider Details

I. General information

NPI: 1639130917
Provider Name (Legal Business Name): DAKOTA FAMILY SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 22ND AVE NW
MINOT ND
58703-0986
US

IV. Provider business mailing address

PO BOX 1148
MINOT ND
58702-1148
US

V. Phone/Fax

Practice location:
  • Phone: 701-837-6508
  • Fax: 701-858-1839
Mailing address:
  • Phone: 701-858-0115
  • Fax: 701-852-1190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier06641001
Identifier TypeOTHER
Identifier StateND
Identifier IssuerBLUE CROSS BLUE SHIELD ND
# 2
Identifier13527
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: MRS. SHONDELL L GANTZER
Title or Position: OFFICE MANAGER
Credential:
Phone: 701-858-0115