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2419 12th Ave S Suite 1 Moorhead MN 56560-3828 | |
| (218) 284-6069 | |
| (218) 284-1146 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2419 12th Ave S, Moorhead, Minnesota |
| Authorized Official Name and Position | Ladonna Korstad (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2182846069 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2419 12th Ave S Suite 1 Moorhead MN 56560-3828 Ph: (218) 284-6069 | 2419 12th Ave S Suite 1 Moorhead MN 56560-3828 Ph: (218) 284-6069 |
| NPI Number | 1073058640 |
|---|---|
| Provider Enumeration Date | 01/05/2017 |
| Last Update Date | 01/05/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073058640 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (Minnesota) | Primary |
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