Healthcare Provider Details

I. General information

NPI: 1285871806
Provider Name (Legal Business Name): CIRCLE OF NATIONS SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2009
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 8TH ST N
WAHPETON ND
58075-3642
US

IV. Provider business mailing address

832 8TH ST N
WAHPETON ND
58075-3642
US

V. Phone/Fax

Practice location:
  • Phone: 701-642-3796
  • Fax: 701-642-1984
Mailing address:
  • Phone: 701-642-3796
  • Fax: 701-642-1984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID R. KEEHN
Title or Position: CEO
Credential:
Phone: 701-642-3796