NPIMap

Organization Active NPI

North Dakota Youth Correctional Center

  • Clinic/Center
  • Mandan, ND
National Provider Identifier
1790080356
Registry record updated Jul 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
NORTH DAKOTA YOUTH CORRECTIONAL CENTER
Practice address
701 16TH Ave SW
Mandan, ND 58554-5800
Phone
(701) 667-1400
Fax
(701) 667-1414
NPI assigned
Jan 12, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2011

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

Authorized official

Name
Mr. Ron Crouse
Title
Director
Phone
(701) 667-1401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

701 16TH Ave SW
Mandan, ND 58554-5800

Mailing address

701 16TH Ave SW
Mandan, ND 58554-5800
Phone (701) 667-1400

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
35D1062169North Dakota Youth Correctional Center701 16TH Ave SW, Mandan, ND 58554Certificate of waiverDec 6, 2026

National Provider Directory

National Provider Directory
Tax ID family
Northeast Human Service8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

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

Locations

701 16th Ave SW
Mandan, ND 58554
Phone (701) 667-1400

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1294790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310515200000",
    "number": "1790080356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 16TH AVE SW",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585545800",
            "telephone_number": "701-667-1400",
            "fax_number": "701-667-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 16TH AVE SW",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585545800",
            "telephone_number": "701-667-1400",
            "fax_number": "701-667-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH DAKOTA YOUTH CORRECTIONAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-12",
        "last_updated": "2011-07-13",
        "status": "A",
        "authorized_official_last_name": "CROUSE",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "701-667-1401",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandan, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.