Provider Demographics
NPI:1588694392
Name:THE VILLAGE FAMILY SERVICE CENTERE
Entity type:Organization
Organization Name:THE VILLAGE FAMILY SERVICE CENTERE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:VANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-451-4900
Mailing Address - Street 1:300 3RD AVE SW
Mailing Address - Street 2:SUITE D
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-4346
Mailing Address - Country:US
Mailing Address - Phone:701-852-9928
Mailing Address - Fax:701-838-2521
Practice Address - Street 1:20 1ST ST SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3851
Practice Address - Country:US
Practice Address - Phone:701-451-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND459-2-1-01261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND=========OtherTAX ID