1548432537 NPI number — FAMILY RESOURCE CENTER

Table of Contents

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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