Organization
FAMILY RECOVERY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DIANA ROY LAC (EXECUTIVE DIRECTOR)
(701) 774-9625
Entity
Organization
Contact information
Practice address
126 W BROADWAY, WILLISTON, ND 58801-6053
(701) 774-9625
(701) 572-4106
Mailing address
126 W BROADWAY, PO BOX 1202, WILLISTON, ND 58802-1202
(701) 774-9625
(701) 572-4106
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01280003
B LUE CROSS
ND
Enumeration date
04/05/2006
Last updated
08/22/2020
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