NPIMap

Organization Active NPI

Charles Hall Youth Services Inc.

  • Voluntary or Charitable Agency
  • Bismarck, ND
National Provider Identifier
1720293301
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Voluntary or Charitable AgencyTaxonomy code 251V00000X
Legal business name
CHARLES HALL YOUTH SERVICES INC.
Practice address
513 E Bismarck Expy
Bismarck, ND 58504-6577
Phone
(701) 255-2773
Fax
(701) 255-6261
NPI assigned
May 14, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Gayle Robert Klopp
Title
Executive Director
Phone
(701) 255-2773

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Voluntary or Charitable Agency 251V00000X NU Primary

Addresses

Primary practice location

513 E Bismarck Expy
Bismarck, ND 58504-6577

Mailing address

513 E Bismarck Expy
Bismarck, ND 58504-6577
Phone (701) 255-2773

Other identifiers 12

IdentifierTypeStateIssuer
19167MedicaidND
27507OtherNDAMY FAST BCBS PIN
27505OtherNDTRIWEST PIN
27506OtherNDKATHRYN KRUKENBERG TRIWES
74004MedicaidND
27506OtherNDKATHRYN KRUKENBERG BCBS
27507OtherNDAMY FAST TRIWEST PIN
50602MedicaidND
74003MedicaidND
74006MedicaidND
27505OtherNDLAVONNA FUCHS - BCBS PIN
74005MedicaidND

National Provider Directory

National Provider Directory

Locations

513 E Bismarck Expy
Bismarck, ND 58504
Phone (701) 255-2773

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1179100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720293301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "513 E BISMARCK EXPY",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585046577",
            "telephone_number": "701-255-2773",
            "fax_number": "701-255-6261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "513 E BISMARCK EXPY",
            "city": "BISMARCK",
            "state": "ND",
            "postal_code": "585046577",
            "telephone_number": "701-255-2773",
            "fax_number": "701-255-6261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES HALL YOUTH SERVICES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KLOPP",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_middle_name": "ROBERT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "701-255-2773",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251V00000X",
            "taxonomy_group": "",
            "desc": "Voluntary or Charitable",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19167",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMY FAST BCBS PIN",
            "identifier": "27507",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST PIN",
            "identifier": "27505",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KATHRYN KRUKENBERG TRIWES",
            "identifier": "27506",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74004",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KATHRYN KRUKENBERG BCBS",
            "identifier": "27506",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMY FAST TRIWEST PIN",
            "identifier": "27507",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "50602",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74003",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74006",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LAVONNA FUCHS - BCBS PIN",
            "identifier": "27505",
            "state": "ND"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74005",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bismarck, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.