Provider Demographics
NPI:1992929913
Name:EAST CENTRAL CENTER FOR EXCEPTIONAL CHILDREN
Entity type:Organization
Organization Name:EAST CENTRAL CENTER FOR EXCEPTIONAL CHILDREN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BSMGR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-947-5015
Mailing Address - Street 1:16 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ROCKFORD
Mailing Address - State:ND
Mailing Address - Zip Code:58356-1520
Mailing Address - Country:US
Mailing Address - Phone:701-947-5015
Mailing Address - Fax:
Practice Address - Street 1:16 S 8TH ST
Practice Address - Street 2:
Practice Address - City:NEW ROCKFORD
Practice Address - State:ND
Practice Address - Zip Code:58356-1520
Practice Address - Country:US
Practice Address - Phone:701-947-5015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19012Medicaid