1548432537 NPI number — FAMILY RESOURCE CENTER

Table of content: (NPI 1548432537)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548432537 NPI number — FAMILY RESOURCE CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY RESOURCE CENTER
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:
1548432537
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 933
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROLLA
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58367-0933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-477-6786
Provider Business Mailing Address Fax Number:
701-477-6312

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BIA HWY 10
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELCOURT
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-477-6786
Provider Business Practice Location Address Fax Number:
701-477-6312
Provider Enumeration Date:
03/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
VIVIER
Authorized Official First Name:
JOYCE
Authorized Official Middle Name:
AMELIA
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
701-477-6786

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X , with the licence number:  1870 , 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: 1D059760 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




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