Healthcare Provider Details

I. General information

NPI: 1811781115
Provider Name (Legal Business Name): GREATER GRAND FORKS SENIOR CITIZENS ASSOC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 4TH AVE S
GRAND FORKS ND
58201-4534
US

IV. Provider business mailing address

620 4TH AVE S
GRAND FORKS ND
58201-4534
US

V. Phone/Fax

Practice location:
  • Phone: 701-772-7245
  • Fax: 701-772-0213
Mailing address:
  • Phone: 701-772-7245
  • Fax: 701-772-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: COLETTE KIM ISEMINGER
Title or Position: EXECUTIVE DIRECTOR
Credential: MS, RD, LRD
Phone: 701-772-7245