Basic Information
| Provider Information | |||||||||
| NPI: | 1366032955 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NORTH DAKOTA AUTISM CENTER, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 647 13TH AVE E STE A | ||||||||
| Address2: | |||||||||
| City: | WEST FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580783328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013679855 | ||||||||
| FaxNumber: | 7012778847 | ||||||||
| Practice Location | |||||||||
| Address1: | 647 13TH AVE E STE A | ||||||||
| Address2: | |||||||||
| City: | WEST FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580783328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012778844 | ||||||||
| FaxNumber: | 7012778847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2021 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | SANDRA | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7012778844 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NORTH DAKOTA AUTISM CENTER, INC | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.