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Intermediate Care Mentally Retarded

Mandan, North Dakota

Provider NPI: 1225386774

Organization Information:
Organization Name:  1303 GROUP HOME
Organization is Subpart
Authorized Official:  MIKE  REMBOLDT  CEO  701-6630379

Practice Location:
1303 7TH AVE SE  MANDAN, ND 58554 US
Tel: 701-663-0379  Fax: --

Business Mailing Address:
1007 18TH ST NW  MANDAN, ND 58554 US
Tel: --  Fax: --

Entity Type: Organization


PrimaryCodeCategory/DescriptionStateLicense Number
Y315P00000XNursing & Custodial Care Facilities
Intermediate Care Facility, Mentally Retarded

Other Provider Identifiers:

Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin


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