1203 GROUPHOME NPI 1407153059

NPI Information

NPI: 1407153059
Provider Name: 1203 GROUPHOME
Classification: Intermediate Care Facility, Intellectual Disabilities - 315P00000X
Entity Type: Organization
Address:
1203 7TH AVE SE
MANDAN, ND
ZIP 58554
Phone: (701) 667-6168
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1203 GROUPHOME is an intermediate care facility mentally retarded in Mandan, ND. The provider is an intermediate care facility providing services for individuals with intellectual disabilities. 1203 GROUPHOME NPI is 1407153059. The provider is registered as an organization entity type.

The provider's business location address is:

1203 7TH AVE SE
MANDAN, ND
ZIP 58554
Phone: (701) 667-6168

The provider's authorized official is Mike Remboldt .
The authorized official title is Ceo and has the following contact phone number (701) 633-0379.

The enumeration date for this NPI number is 2/17/2011 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	30878	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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