Organization · NPI-2
1201 Grouphome
Intermediate Care Facility, Intellectual Disabilities · Mandan, ND
NPI number1598062143
StatusActive
Last updated in NPPESApr 17, 2024
Details
- NPI
- 1598062143
- Entity type
- Organization (NPI-2)
- Legal business name
- 1201 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
1201 7th Ave SeMandan, ND 58554
Phone 701-663-9719
Mailing address
201 4th Ave NwMandan, ND 58554-3135
Authorized official
Mike Remboldt
Ceo
7016630379
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