Healthcare Provider Details

I. General information

NPI: 1720492366
Provider Name (Legal Business Name): EASTER SEALS GOODWILL ND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2014
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 COLLINS AVE
MANDAN ND
58554-3106
US

IV. Provider business mailing address

211 COLLINS AVE
MANDAN ND
58554-3106
US

V. Phone/Fax

Practice location:
  • Phone: 701-663-6828
  • Fax: 701-663-6859
Mailing address:
  • Phone: 701-663-6828
  • Fax: 701-663-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: GORDON L. HAUGE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 701-663-6828