Healthcare Provider Details

I. General information

NPI: 1295255933
Provider Name (Legal Business Name): NORTHWEST HUMAN SERVICE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 12/10/2020
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 2ND AVE W
WILLISTON ND
58801-5218
US

IV. Provider business mailing address

PO BOX 1266
WILLISTON ND
58802-1266
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-4600
  • Fax: 701-774-4620
Mailing address:
  • Phone: 701-774-4600
  • Fax: 701-774-4620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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