| 1517/1519 Home | |
|
1517/1519 S Washington St Bismarck ND 58504 | |
| (701) 222-8017 | |
| Not Available |
| Full Name | 1517/1519 Home |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1517/1519 S Washington St, Bismarck, North Dakota |
| Authorized Official Name and Position | Paul R Kramer (FCO) |
| Authorized Official Contact | 7016678614 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| 1517/1519 Home 201 4th Ave Nw Mandan ND 58554-3135 Ph: (701) 663-0379 | 1517/1519 Home 1517/1519 S Washington St Bismarck ND 58504 Ph: (701) 222-8017 |
| NPI Number | 1619578077 |
|---|---|
| Provider Enumeration Date | 11/03/2020 |
| Last Update Date | 04/17/2024 |
| Certification Date | 04/17/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619578077 | NPI | - | NPPES |
| 1455891 | Medicaid | ND |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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