Provider Demographics
NPI:1144610536
Name:BURLEIGH COUNTY SPECIAL EDUCATION UNIT
Entity type:Organization
Organization Name:BURLEIGH COUNTY SPECIAL EDUCATION UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:RYBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-258-6299
Mailing Address - Street 1:4007 STATE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0648
Mailing Address - Country:US
Mailing Address - Phone:701-258-6299
Mailing Address - Fax:701-258-5195
Practice Address - Street 1:4007 STATE ST
Practice Address - Street 2:STE 101
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0648
Practice Address - Country:US
Practice Address - Phone:701-258-6299
Practice Address - Fax:701-258-5195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND52096251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19010Medicaid