Organization
GRAND FORKS GROWTH AND SUPPORT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE OLSON (CONTROLLER)
(701) 775-2566
Entity
Organization
Contact information
Practice address
2105 GATEWAY DR, GRAND FORKS, ND 58203-1412
(701) 775-2566
Mailing address
2105 GATEWAY DR, GRAND FORKS, ND 58203-1412
(701) 775-2566
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1456174
—
ND
Enumeration date
10/07/2020
Last updated
10/07/2020
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