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NPI Code Detail

MEDICARE: SOUTHEAST HUMAN SERVICE CENTER

MEDICARE: SOUTHEAST HUMAN SERVICE CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD1600XDevelopmental Disabilities Clinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245284850
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEAST HUMAN SERVICE CENTER
Provider Business Mailing Address
First Line : 2624 9TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-2350
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2624 9TH AVE S
Second Line :
City : FARGO
State : ND
Zip : 58103-2350
Country : US
Telephone Number : 701-298-4500
Fax Number :
Authorized Official
Title or Position : ASSISTANT CFO - DHS
Name : DONNA AUKLAND
Credential :
Telephone Number : 701-328-4924
Provider Enumeration Date : 05/19/2006
Last Update Date : 12/10/2020

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Directions to “SOUTHEAST HUMAN SERVICE CENTER ” Practice Location

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