NPIMap

Organization Active NPI

Southeast Human Service Center

  • Developmental Disabilities Clinic/Center
  • Fargo, ND
National Provider Identifier
1245284850
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X
Legal business name
SOUTHEAST HUMAN SERVICE CENTER
Practice address
2624 9TH Ave S
Fargo, ND 58103-2350
Phone
(701) 298-4500
NPI assigned
May 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Donna Aukland
Title
Assistant Cfo - DHS
Phone
(701) 328-4924

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X Primary

Addresses

Primary practice location

2624 9TH Ave S
Fargo, ND 58103-2350

Mailing address

2624 9TH Ave S
Fargo, ND 58103-2350

Other identifiers 1

IdentifierTypeStateIssuer
032318MedicaidND

National Provider Directory

National Provider Directory
Tax ID family
Southeast Behavioral Health Clinic4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1245284850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2624 9TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2624 9TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581032350",
            "telephone_number": "701-298-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HUMAN SERVICE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "AUKLAND",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "ASSISTANT CFO - DHS",
        "authorized_official_telephone_number": "701-328-4924"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "032318",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.