Healthcare Provider Details

I. General information

NPI: 1285771303
Provider Name (Legal Business Name): PEMBINA SPECIAL EDUCATION COOPERATIVE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106B DIVISION AVE.
CAVALIER ND
58220
US

IV. Provider business mailing address

106B DIVISION AVE.
CAVALIER ND
58220
US

V. Phone/Fax

Practice location:
  • Phone: 701-265-8080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateND

VIII. Authorized Official

Name: TOM CUMMINGS
Title or Position: DIRECTOR
Credential:
Phone: 701-265-8080