Provider Demographics
NPI:1285056507
Name:BURLEIGH COUNTY HUMAN SERVICE ZONE
Entity type:Organization
Organization Name:BURLEIGH COUNTY HUMAN SERVICE ZONE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ZONE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-222-6670
Mailing Address - Street 1:415 E ROSSER AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4058
Mailing Address - Country:US
Mailing Address - Phone:701-222-6670
Mailing Address - Fax:701-221-3384
Practice Address - Street 1:415 E ROSSER AVE STE 113
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4058
Practice Address - Country:US
Practice Address - Phone:701-222-6670
Practice Address - Fax:701-221-3384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND000050718Medicaid