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General NPI Number Information
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NPI Number | 1205932233
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Entity Type | Organization
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Legal Business Name | HEART RIVER ALCOHOL AND DRUG ABUSE SERVICES INC.
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Dates
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Enumeration Date | 09/16/2006
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | ST JOE'S PLAZA 30 7TH ST W
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City | DICKINSON
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State | ND
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Zip | 58601-4335
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Country | US
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Telephone | 701-483-0795
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Fax | 701-483-0947
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Provider Business Mailing Address
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Address Line | ST JOE'S PLAZA 30 7TH ST W
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City | DICKINSON
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State | ND
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Zip | 58601-4335
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Country | US
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Telephone | 701-483-0795
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Fax | 701-483-0947
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Authorized Official
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Title or Position | LAC
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Name | MR. JOHN H. WIEGLENDA
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Credential | LAC
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Telephone | 701-483-0795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | 1071
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1071
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License Number State | ND
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