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NPI Code Detail

MEDICARE: GOOD ROAD RECOVERY CENTER

MEDICARE: GOOD ROAD RECOVERY CENTER
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
1251B00000XCase Management Agency
2177F00000XLodging Provider
3101YA0400XAddiction (Substance Use Disorder) Counselor
4174200000XMeals Provider
5324500000XSubstance Abuse Rehabilitation Facility

General Provider Information

NPI Number : 1629544267
Entity Type Code : Organization
Provider Name (Legal Business Name) : GOOD ROAD RECOVERY CENTER
Provider Business Mailing Address
First Line : 1308 ELBOWOOD LN
Second Line :
City : BISMARCK
State : ND
Zip : 58503-5712
Country : US
Telephone Number : 701-751-8260
Fax Number :
Provider Business Practice Location Address
First Line : 1308 ELBOWOOD LN
Second Line :
City : BISMARCK
State : ND
Zip : 58503-5712
Country : US
Telephone Number : 701-751-8260
Fax Number :
Authorized Official
Title or Position : BILLING SPECIALIST
Name : SHERRY MICHELLE BAKER
Credential : CPC
Telephone Number : 701-751-8260
Provider Enumeration Date : 10/22/2018
Last Update Date : 10/22/2018

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Directions to “GOOD ROAD RECOVERY CENTER ” Practice Location

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