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NPI Code Detail

MEDICARE: MONTERA HEALTH NORTH DAKOTA LLC

MEDICARE: MONTERA HEALTH NORTH DAKOTA LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1407503097
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONTERA HEALTH NORTH DAKOTA LLC
Provider Business Mailing Address
First Line : 3003 32ND AVE S STE 240
Second Line :
City : FARGO
State : ND
Zip : 58103-6118
Country : US
Telephone Number : 865-680-1516
Fax Number :
Provider Business Practice Location Address
First Line : 3003 32ND AVE S STE 240
Second Line :
City : FARGO
State : ND
Zip : 58103-6118
Country : US
Telephone Number : 865-680-1516
Fax Number :
Authorized Official
Title or Position : ADMIN
Name : QINGQING MAO
Credential :
Telephone Number : 415-805-1725
Provider Enumeration Date : 03/03/2022
Last Update Date : 01/31/2024

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Directions to “MONTERA HEALTH NORTH DAKOTA LLC ” Practice Location

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