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General NPI Number Information
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NPI Number | 1568916989
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Entity Type | Organization
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Legal Business Name | PRIDE MANCHESTER HOPE HOME INC
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Dates
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Enumeration Date | 08/15/2016
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Last Update Date | 08/15/2016
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Provider Practice Location Address
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Address Line | 7301 KEEPSAKE LN
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City | BISMARCK
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State | ND
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Zip | 58501-8664
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Country | US
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Telephone | 701-751-3013
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4086
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City | BISMARCK
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State | ND
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Zip | 58502-4086
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Country | US
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Telephone | 701-751-3013
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHARLES BISNETT
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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 | 05741
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License Number State | ND
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