Healthcare Provider Details

I. General information

NPI: 1205753480
Provider Name (Legal Business Name): WILDROSE PUBLIC TRANSPORTATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 1ST AVE NE
CROSBY ND
58730-3800
US

IV. Provider business mailing address

PO BOX 123
CROSBY ND
58730-0123
US

V. Phone/Fax

Practice location:
  • Phone: 701-641-0994
  • Fax:
Mailing address:
  • Phone: 701-641-0994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: AMBER HAUGENOE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 701-641-0994