Organization
MINOT VOC ADJ WORKSHOP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OWEN H LARSON LCSW (PRESIDENT CEO)
(701) 852-1014
Entity
Organization
Contact information
Practice address
605 27TH ST SE, MINOT, ND 58701-5169
(701) 852-1014
(701) 852-1139
Mailing address
PO BOX 1030, MINOT, ND 58702-1030
(701) 852-1014
(701) 852-1139
Taxonomy
Speciality
Code
Description
License number
State
315P00000X
Intellectual Disabilities Intermediate Care Facility
Primary
—
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30820
—
ND
Enumeration date
12/08/2006
Last updated
08/22/2020
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