1203 Grouphome

NPI 1407153059 - Intermediate Care Facility, Mentally Retarded - 315P00000X

NPI Details
NPI 1407153059
Enumeration Date 02/17/2011
Last Updated 02/17/2011
Entity Type Healthcare Provider
Active Over 5 years ago
Authorized Information
Name MIKE MIKE
Position CEO
Phone (701) 667-6168
Fax
Practice Location
1203 7TH AVE SE
MANDAN ND, 58554, US
Phone (701) 667-6168
Fax
Business Location
1007 18TH ST NW
MANDAN ND, 58554-1639, US
Phone
Fax
Toxanomy
Taxonomy Code 315P00000X
License State
License Number
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According to our database, 1203 Grouphome NPI is 1407153059, taxonomy code is 315P00000X 1203 Grouphome physically located at 1203 7th Ave Se, Mandan ND, 58554. NPI Number 1033115704 has the healthcare provider type.

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1407153059 NPI number is provided on an as is basis without warranty of any kind. 1407153059 is maintained by the National Plan & Provider Enumeration System. The contents of 1203 Grouphome are for informational purposes only.