Northeast Human Service Center
Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Grand Forks, ND
NPI 1891808978 · NPPES record last updated Dec 10, 2020
Key facts
- NPI
- 1891808978
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- License
- 1049 (ND)
- Legal business name
- NORTHEAST HUMAN SERVICE CENTER
- Practice address
- 151 S 4TH St Ste 401
Grand Forks, ND 58201-4715 - Phone
- (701) 795-3000
- Fax
- (701) 795-3050
- NPI assigned
- Aug 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Donna Aukland
- Title
- Assistant Cfo - DHS
- Phone
- (701) 328-4924
Other NPIs on the same Medicare enrollment 1
Corporate family (same tax ID) 3
Practitioners 76
-
Yawar Abbas, MD
-
Jessica Rose Bodine, LAC
-
Michael Capan, M.D.
-
Tarah E Cavett, LPC
-
Lincoln D. Coombs, PSY.D.
-
Larry Gerard Dauksavage, LCSW
-
Ella Davis, LMSW
-
Katrina Marie Dedona, PSYD
-
Nicole Delaplane, LCSW
-
Jean Ann Driscoll, LCSW
-
Nicole Lynn Erasmus, MSW, LICSW
-
Lori Jo Esprit, M.D.
-
Amy M Fox, LPC, NCC
-
Desiree Joanne Gagner-Tjellesen, RNCS,APRN,BC
-
Amy Linette Hatcher, LCSW
-
Courtney Haviland, LCSW
-
Michael K Heck, DO
-
Joni Heine, LICSW
-
Christina Hemmer, LPC
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040729000033 | ND | Part B Supplier - Clinic/Group Practice | 1658341441 |
Receives reassigned benefits from 77 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Grand Forks, ND |
National Provider Directory
- Tax ID family
- Northeast Behavioral Health Clinic
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | 1049 | ND | Yes |
Addresses
Primary practice location
151 S 4TH St Ste 401
Grand Forks, ND 58201-4715
Mailing address
770 S 14TH St
Grand Forks, ND 58201-4356
Phone (701) 795-3870
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10330 | Other | ND | BCBS ND PROVIDER NUMBER |
Other names
- Ruth Meier's Psychiatric Resedential Treatment Facility
Other providers in Grand Forks, ND
- North Dakota Eye Clinic, LTD
- North Dakota Surgery Center, LLC
- Northeast Behavioral Health Clinic
- Northeast Behavioral Health Clinic
- Northeast Human Service Center
- Northern Natural Medicine PLLC
- Northern Plains Dental P.C.
- Northern Valley Obstetrics & Gynecology, P.C.
- Northern Valley Transport
- Northland Christian Counseling Center Inc
All providers in Grand Forks, ND · Emotionally Disturbed Childrens' Residential Treatment Facility in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.