1306014022 NPI number — DEVELOPMENT HOMES INC

Table of content: (NPI 1306014022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306014022 NPI number — DEVELOPMENT HOMES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEVELOPMENT HOMES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306014022
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3880 SOUTH COLUMBIA ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND FORKS
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-335-4000
Provider Business Mailing Address Fax Number:
701-335-4004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2585 19TH ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND FORKS
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-335-4000
Provider Business Practice Location Address Fax Number:
701-335-4004
Provider Enumeration Date:
02/15/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARSHALL
Authorized Official First Name:
SANDI
Authorized Official Middle Name:
Authorized Official Title or Position:
DEO
Authorized Official Telephone Number:
701-335-4000

Provider Taxonomy Codes

  • Taxonomy code: 315P00000X , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30837 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".