Healthcare Provider Details

I. General information

NPI: 1013842871
Provider Name (Legal Business Name): NORTH DAKOTA ADULT FOSTER CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6718 67TH AVE S
HORACE ND
58047-5726
US

IV. Provider business mailing address

6718 67TH AVE S
HORACE ND
58047-5726
US

V. Phone/Fax

Practice location:
  • Phone: 609-310-2642
  • Fax: 609-310-2642
Mailing address:
  • Phone: 609-310-2642
  • Fax: 609-310-2642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: HANNIBAL D BLOJAY
Title or Position: DIRECTOR
Credential:
Phone: 609-310-2642