Healthcare Provider Details

I. General information

NPI: 1851476105
Provider Name (Legal Business Name): DAKOTA BOYS & GIRLS RANCH ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 N 35TH ST
BISMARCK ND
58501-7722
US

IV. Provider business mailing address

1227 N 35TH ST
BISMARCK ND
58501-7722
US

V. Phone/Fax

Practice location:
  • Phone: 701-858-0115
  • Fax:
Mailing address:
  • Phone: 701-858-0115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number StateND

VIII. Authorized Official

Name: TAMMY MORENO
Title or Position: CREDENTIALING
Credential:
Phone: 701-364-2950