Organization
4TH CORPORAITON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KODI KELLER (EXECUTIVE DIRECTOR)
(701) 947-2147
Entity
Organization
Contact information
Practice address
1006 2ND AVENUE NORTH, NEW ROCKFORD, ND 58356
(701) 947-2147
Mailing address
120 11TH STREET NORTH, NEW ROCKFORD, ND 58356
(701) 947-2147
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/27/2020
Last updated
10/27/2020
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