Organization
4TH CORPORAITON
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
—
ND
Other
Enumeration date
01/02/2007
Last updated
02/15/2008
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