Healthcare Provider Details

I. General information

NPI: 1427659036
Provider Name (Legal Business Name): REM NORTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2020
Last Update Date: 04/22/2023
Certification Date: 04/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 2ND ST SE STE 1A
MINOT ND
58701-6566
US

IV. Provider business mailing address

1905 2ND ST SE STE 1A
MINOT ND
58701-6566
US

V. Phone/Fax

Practice location:
  • Phone: 701-418-2010
  • Fax:
Mailing address:
  • Phone: 701-418-2010
  • Fax:

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:

# 1
Identifier1467996
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name: BRETT IAN COHEN
Title or Position: COO
Credential:
Phone: 800-388-5150