| NPI | 1235309063 |
|---|---|
| Other Name | 304 GROUP HOME |
| Entity Type | Organization |
| Authorized Contact | MIKE REMBOLDT CEO 701-663-0379 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 315P00000X Intermediate Care Facility, Intellectual Disabilities |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2025-06-23 |