Healthcare Provider Details

I. General information

NPI: 1427656560
Provider Name (Legal Business Name): MINOT VOCATIONAL ADJUSTMENT WORKSHOP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 27TH ST SE
MINOT ND
58701-5169
US

IV. Provider business mailing address

605 27TH ST SE PO BOX 1030
MINOT ND
58701
US

V. Phone/Fax

Practice location:
  • Phone: 701-852-1014
  • Fax:
Mailing address:
  • Phone: 701-852-1014
  • Fax: 701-852-1139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MISTY WANNER
Title or Position: CFO
Credential: CPA
Phone: 701-852-1014