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Individual

BEARS STAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1308 ELBOWOOD LN, BISMARCK, ND 58503-5712
(701) 751-8260
Mailing address
1308 ELBOWOOD LN, BISMARCK, ND 58503-5712
(701) 751-8260

Taxonomy

Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
172A00000X
Driver
Primary
175T00000X
Peer Specialist

Other

Enumeration date
04/19/2023
Last updated
04/19/2023
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