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General NPI Number Information
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NPI Number | 1780236935
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Entity Type | Organization
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Legal Business Name | SOUTHWEST MULTI-COUNTY CORRECTION CENTER
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Dates
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Enumeration Date | 07/09/2019
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Last Update Date | 07/09/2019
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Provider Practice Location Address
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Address Line | 66 W MUSEUM DR
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City | DICKINSON
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State | ND
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Zip | 58601-3864
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Country | US
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Telephone | 701-456-7728
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Fax | 701-456-7687
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Provider Business Mailing Address
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Address Line | 440 MCKENZIE ST
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City | NEW ENGLAND
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State | ND
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Zip | 58647-7310
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Country | US
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Telephone | 701-579-5100
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Fax | 701-579-5100
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Authorized Official
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Title or Position | WARDEN
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Name | RACHELLE JUNTUNEN
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Credential | LAC
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Telephone | 701-579-5100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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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 |
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License Number State |
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