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General NPI Number Information
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NPI Number | 1346351475
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Entity Type | Organization
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Legal Business Name | PRIDE MANCHESTER INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/01/2014
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Provider Practice Location Address
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Address Line | 1200 MISSOURI AVE
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City | BISMARCK
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State | ND
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Zip | 58504-5264
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Country | US
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Telephone | 701-258-7838
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Fax | 701-258-3735
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Provider Business Mailing Address
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Address Line | 1200 MISSOURI AVE
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City | BISMARCK
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State | ND
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Zip | 58504-5264
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Country | US
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Telephone | 701-258-7838
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Fax | 701-258-3735
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Authorized Official
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Title or Position | FINANCIAL COORDINATOR
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Name | DARLA ROGGENBUCK
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Credential |
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Telephone | 701-258-7838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 322D00000X
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Taxonomy Name | Emotionally Disturbed Childrens' Residential Treatment Facility
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License Number |
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License Number State |
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