Organization
4TH CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KODI KELLER (BUSINESS MANAGER)
(701) 947-2147
Entity
Organization
Contact information
Practice address
120 11TH ST N, NEW ROCKFORD, ND 58356-1434
(701) 947-2147
Mailing address
120 11TH ST N, NEW ROCKFORD, ND 58356-1434
(701) 947-2147
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
ND01161
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30818
—
ND
Enumeration date
02/20/2008
Last updated
02/20/2008
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