Healthcare Provider Details

I. General information

NPI: 1417090861
Provider Name (Legal Business Name): THE FRED AND CLARA ECKERT FOUNDATION FOR CHILDREN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 EAST 11TH STREET
WILLISTON ND
58801
US

IV. Provider business mailing address

PO BOX 2291
WILLISTON ND
58802-2291
US

V. Phone/Fax

Practice location:
  • Phone: 701-572-7262
  • Fax:
Mailing address:
  • Phone: 701-577-0270
  • Fax: 701-577-0271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MAGDA CASTILLO
Title or Position: ADMIN
Credential:
Phone: 701-572-6181