Healthcare Provider Details

I. General information

NPI: 1174265359
Provider Name (Legal Business Name): BLESSED BUILDERS - MINISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 06/24/2022
Certification Date: 06/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 STATE ST STE F6
BISMARCK ND
58503-0669
US

IV. Provider business mailing address

376 LUNAR LN
BISMARCK ND
58503-0468
US

V. Phone/Fax

Practice location:
  • Phone: 701-390-5033
  • Fax:
Mailing address:
  • Phone: 701-390-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAL C BLOOM
Title or Position: DIRECTOR
Credential:
Phone: 701-390-5033