| Grand Forks Growth And Support Center | |
|
2105 Gateway Dr Grand Forks ND 58203-1412 | |
| (701) 775-2566 | |
| Not Available |
| Full Name | Grand Forks Growth And Support Center |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2105 Gateway Dr, Grand Forks, North Dakota |
| Authorized Official Name and Position | Mike Olson (CONTROLLER) |
| Authorized Official Contact | 7017752566 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Grand Forks Growth And Support Center 2105 Gateway Dr Grand Forks ND 58203-1412 Ph: (701) 775-2566 | Grand Forks Growth And Support Center 2105 Gateway Dr Grand Forks ND 58203-1412 Ph: (701) 775-2566 |
| NPI Number | 1679170179 |
|---|---|
| Provider Enumeration Date | 10/07/2020 |
| Last Update Date | 10/07/2020 |
| Certification Date | 10/07/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679170179 | NPI | - | NPPES |
| 1456174 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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