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General NPI Number Information
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NPI Number | 1114048527
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Entity Type | Organization
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Legal Business Name | BRIGHTWATER HEALTH DBA HUMAN DEVELOPMENT CENTER
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 40 11TH ST
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City | CLOQUET
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State | MN
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Zip | 55720-1817
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Country | US
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Telephone | 218-879-4559
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Fax | 218-879-0282
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Provider Business Mailing Address
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Address Line | 1401 E 1ST ST
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City | DULUTH
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State | MN
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Zip | 55805-2407
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Country | US
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Telephone | 218-728-4491
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Fax | 218-730-2367
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Authorized Official
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Title or Position | CHIEF EXECUTIVE DIRECTOR
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Name | BENJMAIN HATFIELD
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Credential | MSW, LICSW, LADC
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Telephone | 218-728-4491
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 8534482
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License Number State | MN
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