Healthcare Provider Details

I. General information

NPI: 1275208001
Provider Name (Legal Business Name): NATIVE COMMUNITY DEVELOPMENT, INC. DBA NATIVE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 E THAYER AVE
BISMARCK ND
58501-5014
US

IV. Provider business mailing address

2403 E THAYER AVE
BISMARCK ND
58501-5014
US

V. Phone/Fax

Practice location:
  • Phone: 701-595-5181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LORRAINE DAVIS
Title or Position: CEO
Credential:
Phone: 701-595-5181