| Organization Name: | SPIRIT LAKE HEAD START |
| NPI Number: | 1093015265 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARIA LANE KOCH (HEALTH SERVICE COORDINATOR) |
| Mailing Address: | 816 3rd Ave North Fort Totten |
| State: | ND US |
| Postal Code: | 58335 |
| Phone Number: | 7017664070 |
| Fax Number: | 7017661357 |
| NPI Enumeration Date: | 10/22/2010 |
| NPI Last Update Date: | 10/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QH0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Health Service |
| Taxonomy Definition: | |