1203 Grouphome

LBN: 1203 Grouphome
1203 Grouphome is an health care organization with primary practice located at 1203 7Th Ave Se , Mandan ND 58554. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded, which is considered as the primary health care specialty. 1203 Grouphome can be contacted via phone (701) 667-6168, or through Remboldt, Mike via phone (701) 633-0379.

Contact Information

Primary practice address
1203 7Th Ave Se Mandan ND 58554
Phone: (701) 667-6168
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Remboldt, Mike
Phone: (701) 633-0379

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Intermediate Care Facility, Mentally Retarded 315P00000X

Profile Details

NPI number 1407153059
LBN Legal business name 1203 Grouphome
DBA Doing business as
Authorized official Remboldt, Mike
Entity Organization
Organization subpart 1 Yes
Enumeration date Feb 17th, 2011
Last updated Apr 17th, 2024 - about 7 months ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407153059 NPPES
North Dakota MEDICAID 30878

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