Healthcare Provider Details

I. General information

NPI: 1508548819
Provider Name (Legal Business Name): MOTT HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MILLIONAIRE AVE
MOTT ND
58646-7270
US

IV. Provider business mailing address

PO BOX 32
MOTT ND
58646-0032
US

V. Phone/Fax

Practice location:
  • Phone: 701-824-3222
  • Fax: 701-824-2113
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: JODI MOORE
Title or Position: ADMINISTRATOR
Credential: PA-C
Phone: 701-290-0690