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Intermediate Care Mentally Retarded

Grand Forks, North Dakota

Provider NPI: 1023286747

Organization Information:
Organization is not Subpart
Authorized Official:  SANDI  MARSHALL  CEO  701-3354000

Practice Location:
1551 24TH AVE S  GRAND FORKS, ND 58201 US
Tel: 701-335-4000  Fax: 701-335-4004

Business Mailing Address:
Tel: 701-335-4000  Fax: 701-335-4004

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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