Organization
RICHARD P STADTER PSYCHIATRIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS PETERSON MD (PRESIDENT/ CHIEF MEDICAL OFFICER)
(701) 772-2500
Entity
Organization
Contact information
Practice address
1451 44TH AVE S STE A, GRAND FORKS, ND 58201-3434
(701) 772-2500
(701) 787-8996
Mailing address
1451 44TH AVE S, PO BOX 14354, GRAND FORKS, ND 58201-3434
(701) 772-2500
(701) 732-2685
Taxonomy
Speciality
Code
Description
License number
State
283Q00000X
Psychiatric Hospital
Primary
5066A
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01426
—
ND
01
—
12039
NDBCBS
ND
01
—
2F78HRI
MNBCBS
MN
05
—
712617400
—
MN
Enumeration date
06/04/2006
Last updated
06/24/2015
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