=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134955982
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REWIRE IN HOPE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2024
-----------------------------------------------------
Last Update Date | 09/09/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1809 4TH AVE SW
-----------------------------------------------------
City | MANDAN
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58554-5713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-288-5034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1809 4TH AVE SW
-----------------------------------------------------
City | MANDAN
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58554-5713
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-288-5034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ROSINE MOIRE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-288-5034
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 320700000X
-----------------------------------------------------
Taxonomy Name | Physical Disabilities Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 320800000X
-----------------------------------------------------
Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------