Healthcare Provider Details

I. General information

NPI: 1528634359
Provider Name (Legal Business Name): WILLISTON COUNCIL FOR THE AGING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 06/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 MAIN ST
WILLISTON ND
58801-6017
US

IV. Provider business mailing address

18 MAIN ST
WILLISTON ND
58801-6017
US

V. Phone/Fax

Practice location:
  • Phone: 701-577-6751
  • Fax:
Mailing address:
  • Phone: 701-577-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332U00000X
TaxonomyHome Delivered Meals
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License Number
License Number State

VIII. Authorized Official

Name: DAVID RICHTER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 701-577-6751