Provider Demographics
NPI:1285934877
Name:EARLY EXPLORERS HEAD START/EARLY HEAD START
Entity type:Organization
Organization Name:EARLY EXPLORERS HEAD START/EARLY HEAD START
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRIESSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-537-5409
Mailing Address - Street 1:701 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:TOWNER
Mailing Address - State:ND
Mailing Address - Zip Code:58788-4225
Mailing Address - Country:US
Mailing Address - Phone:701-537-5409
Mailing Address - Fax:701-537-5312
Practice Address - Street 1:701 MAIN ST N
Practice Address - Street 2:
Practice Address - City:TOWNER
Practice Address - State:ND
Practice Address - Zip Code:58788-4225
Practice Address - Country:US
Practice Address - Phone:701-537-5409
Practice Address - Fax:701-537-5312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND52390Medicaid