SOUTHEAST HUMAN SERVICE CENTER NPI 1932146941

NPI Information

NPI: 1932146941
Provider Name: SOUTHEAST HUMAN SERVICE CENTER
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

CLIA Number: 35D2079903

Address:
2624 9TH AVE S
FARGO, ND
ZIP 58103
Phone: (701) 298-4500
Get Directions

SOUTHEAST HUMAN SERVICE CENTER is a rehabilitation and substance use disorder clinic center in Fargo, ND. SOUTHEAST HUMAN SERVICE CENTER NPI is 1932146941. The provider is registered as an organization entity type.

The provider's business location address is:

2624 9TH AVE S
FARGO, ND
ZIP 58103-350
Phone: (701) 298-4500
Fax: (701) 298-4400

The provider's authorized official is Jeffrey J Stenseth .
The authorized official title is Director and has the following contact phone number (701) 298-4500.

The CLIA number assigned to this NPI record is 35D2079903 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/31/2006 and was last updated on 12/10/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261Q00000X	Clinic/Center				No
2	261QM0801X	Clinic/Center	Mental Health (Including Community Mental Health Center)			No
3	261QM0850X	Clinic/Center	Adult Mental Health			No
4	261QM0855X	Clinic/Center	Adolescent and Children Mental Health			No
5	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	1015	NORTH DAKOTA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	054520	MEDICAID	NORTH DAKOTA
2	100001	OTHER	NORTH DAKOTA	BCBS OF ND
3	90981SO	OTHER	MINNESOTA	BCBS OF MN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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