1203 Grouphome
Intermediate Care Facility, Intellectual Disabilities in Mandan, ND. Organization (NPI-2).
NPI number1407153059
StatusActive
Last updated in NPPESApr 17, 2024
Details
- NPI
- 1407153059
- Entity type
- Organization (NPI-2)
- Legal business name
- 1203 Grouphome
- Organization subpart
- Yes
- Enumeration date
- Feb 17, 2011
- Certification date
- Apr 17, 2024
- Last updated
- Apr 17, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 315P00000X | Intermediate Care Facility, Intellectual Disabilities | – | – | Yes |
Practice location
1203 7th Ave SeMandan, ND 58554
Phone 701-667-6168
Mailing address
201 4th Ave NwMandan, ND 58554-3135
Authorized official
Mike Remboldt
Ceo
7016330379
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