1303 GROUP HOME NPI 1225386774

NPI Information

NPI: 1225386774
Provider Name: 1303 GROUP HOME
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
1303 7TH AVE SE
MANDAN, ND
ZIP 58554
Phone: (701) 663-0379
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1303 GROUP HOME is an intermediate care facility mentally retarded in Mandan, ND. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. 1303 GROUP HOME NPI is 1225386774. The provider is registered as an organization entity type.

The provider's business location address is:

1303 7TH AVE SE
MANDAN, ND
ZIP 58554-506
Phone: (701) 663-0379

The provider's authorized official is Mike Remboldt .
The authorized official title is Ceo and has the following contact phone number (701) 663-0379.

The enumeration date for this NPI number is 8/15/2012 and was last updated on 4/17/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	315P00000X	Intermediate Care Facility, Intellectual Disabilities				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1456205	MEDICAID	NORTH DAKOTA
2	30879	MEDICAID	NORTH DAKOTA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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