Healthcare Provider Details

I. General information

NPI: 1174974877
Provider Name (Legal Business Name): RED RIVER BEHAVIORAL HEALTH SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 44TH AVE S
GRAND FORKS ND
58201-3434
US

IV. Provider business mailing address

550 MAIN STREET SUITE 250, CONTRACTING/CREDENTIALING
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-772-2500
  • Fax: 701-757-1512
Mailing address:
  • Phone: 612-326-7575
  • Fax: 612-454-2430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES SMITH
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 612-326-7575