Healthcare Provider Details

I. General information

NPI: 1679597264
Provider Name (Legal Business Name): RURAL MENTAL HEALTH CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 OHMER STREET
BOTTINEAU ND
58318-1045
US

IV. Provider business mailing address

316 OHMER STREET
BOTTINEAU ND
58318-1045
US

V. Phone/Fax

Practice location:
  • Phone: 701-228-9441
  • Fax: 701-385-4295
Mailing address:
  • Phone: 701-228-9441
  • Fax: 701-385-4295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER R. ALBERTSON
Title or Position: PRESIDENT
Credential:
Phone: 701-550-1371