Healthcare Provider Details

I. General information

NPI: 1053071886
Provider Name (Legal Business Name): HOLISTIC RECOVERY TRAINING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2021
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 2ND ST SW UNIT 1056
JAMESTOWN ND
58402-6644
US

IV. Provider business mailing address

212 2ND ST SW UNIT 1056
JAMESTOWN ND
58402-6644
US

V. Phone/Fax

Practice location:
  • Phone: 701-680-5207
  • Fax: 701-291-4389
Mailing address:
  • Phone: 701-680-5207
  • Fax: 701-291-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA GORE
Title or Position: OWNER
Credential: LMAC
Phone: 701-680-5207