Healthcare Provider Details

I. General information

NPI: 1346761442
Provider Name (Legal Business Name): NORTH CENTRAL HUMAN SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2017
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

IV. Provider business mailing address

1015 S BROADWAY STE 18
MINOT ND
58701-4667
US

V. Phone/Fax

Practice location:
  • Phone: 701-857-8500
  • Fax: 701-857-8555
Mailing address:
  • Phone: 701-857-8500
  • Fax: 701-857-8555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VII. Legacy identifiers

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

# 1
IdentifierND249515
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: CARMEN JACKSON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 701-298-4690