Healthcare Provider Details

I. General information

NPI: 1992929913
Provider Name (Legal Business Name): EAST CENTRAL CENTER FOR EXCEPTIONAL CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 S 8TH ST
NEW ROCKFORD ND
58356-1520
US

IV. Provider business mailing address

16 S 8TH ST
NEW ROCKFORD ND
58356-1520
US

V. Phone/Fax

Practice location:
  • Phone: 701-947-5015
  • Fax:
Mailing address:
  • Phone: 701-947-5015
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CINDY K JOHNSON
Title or Position: BSMGR
Credential:
Phone: 701-947-5015