Healthcare Provider Details

I. General information

NPI: 1548432537
Provider Name (Legal Business Name): FAMILY RESOURCE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BIA HWY 10
BELCOURT ND
58316
US

IV. Provider business mailing address

PO BOX 933
ROLLA ND
58367-0933
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-6786
  • Fax: 701-477-6312
Mailing address:
  • Phone: 701-477-6786
  • Fax: 701-477-6312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number1870
License Number StateND

VIII. Authorized Official

Name: JOYCE AMELIA VIVIER
Title or Position: EXECUTIVE DIRECTOR
Credential: LSW
Phone: 701-477-6786