Basic Information
| Provider Information | |||||||||
| NPI: | 1205957610 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HUMAN DEVELOPMENT CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1401 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | DULUTH | ||||||||
| State: | MN | ||||||||
| PostalCode: | 558052407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2187284491 | ||||||||
| FaxNumber: | 2187284404 | ||||||||
| Practice Location | |||||||||
| Address1: | 1807 WEST HWY 61 | ||||||||
| Address2: | P.O. BOX 847 | ||||||||
| City: | GRAND MARAIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 556040847 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2183879444 | ||||||||
| FaxNumber: | 2183879435 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GETCHELL | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2187284491 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 8534482 | MN | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 186818701 | 05 | MN | MEDICAID |