Healthcare Provider Details

I. General information

NPI: 1225217300
Provider Name (Legal Business Name): HARMONY HOUSE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2007
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 COLLEGE DR N C/O SPORTS CENTER
DEVILS LAKE ND
58301-1550
US

IV. Provider business mailing address

1601 COLLEGE DR N C/O SPORTS CENTER
DEVILS LAKE ND
58301-1550
US

V. Phone/Fax

Practice location:
  • Phone: 701-662-8393
  • Fax:
Mailing address:
  • Phone: 701-662-8393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: NANCY J THOMPSON
Title or Position: LICENSED SOCIAL WORKER
Credential:
Phone: 701-662-8393