| Faa Addiction Services | |
|
900 N Broadway Ste 111 Minot ND 58703-2378 | |
| (701) 537-4191 | |
| Not Available |
| Full Name | Faa Addiction Services |
|---|---|
| Speciality | Counselor - Addiction (substance Use Disorder) |
| Location | 900 N Broadway Ste 111, Minot, North Dakota |
| Authorized Official Name and Position | Shondell Gantzer (OFFICE MANAGER) |
| Authorized Official Contact | 7017202964 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Faa Addiction Services 900 N Broadway Ste 111 Minot ND 58703-2378 Ph: (701) 537-4191 | Faa Addiction Services 900 N Broadway Ste 111 Minot ND 58703-2378 Ph: (701) 537-4191 |
| NPI Number | 1659926681 |
|---|---|
| Provider Enumeration Date | 08/06/2019 |
| Last Update Date | 02/05/2020 |
| Certification Date | 02/05/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659926681 | NPI | - | NPPES |
| 159488 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | (* (Not Available)) | Primary |
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