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Intermediate Care Mentally Retarded

New Rockford, North Dakota

Provider NPI: 1740347764

Organization Information:
Organization Name:  4TH CORPORAITON
Organization is not Subpart
Authorized Official:  KODI  KELLER  BUSINESS MANAGER  701-9472147

Practice Location:
120 11TH ST N  NEW ROCKFORD, ND 58356 US
Tel: 701-947-2147  Fax: --

Business Mailing Address:
120 11TH ST N  NEW ROCKFORD, ND 58356 US
Tel: 701-947-2147  Fax: --

Entity Type: Organization


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


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