Provider Demographics
NPI:1013524438
Name:DAKOTA ESTATES INCORPORATED
Entity type:Organization
Organization Name:DAKOTA ESTATES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/ ADMINISTRATIVE ASS
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOYTASSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-538-4566
Mailing Address - Street 1:440 WILEY AVE. S.
Mailing Address - Street 2:
Mailing Address - City:LIDGERWOOD
Mailing Address - State:ND
Mailing Address - Zip Code:58053
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:440 WILEY AVE. S.
Practice Address - Street 2:
Practice Address - City:LIDGERWOOD
Practice Address - State:ND
Practice Address - Zip Code:58053
Practice Address - Country:US
Practice Address - Phone:701-538-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1463669Medicaid