Organization
CHARLES HALL YOUTH SERVICES INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GAYLE ROBERT KLOPP (EXECUTIVE DIRECTOR)
(701) 255-2773
Entity
Organization
Contact information
Practice address
513 E BISMARCK EXPY, BISMARCK, ND 58504-6577
(701) 255-2773
(701) 255-6261
Mailing address
513 E BISMARCK EXPY, BISMARCK, ND 58504-6577
(701) 255-2773
(701) 255-6261
Taxonomy
Speciality
Code
Description
License number
State
251V00000X
Voluntary or Charitable Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19167
—
ND
01
—
27505
LAVONNA FUCHS - BCBS PIN
ND
01
—
27506
KATHRYN KRUKENBERG TRIWES
ND
01
—
27507
AMY FAST TRIWEST PIN
ND
05
—
50602
—
ND
05
—
74003
—
ND
05
—
74004
—
ND
05
—
74005
—
ND
05
—
74006
—
ND
Enumeration date
05/14/2007
Last updated
08/22/2020
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