304 (NPI# 1235309063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235309063 |
| Entity Type | Organization |
| Organization Name | 304 |
| Other Organization Name | DIANES GROUP HOME |
| Practice Address |
304 11th St Ne Mandan ND 58554-2140 |
| Mailing Address |
1007 18th St Nw Mandan ND 58554-1639 |
| Practice Telephone | 7016631635 |
| Mailing Telephone | 7016630379 |
| Mailing Fax Number | 7016631535 |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2020-10-30 |
| Authorized Official Name | MIKE REMBOLDT (CEO) |
| Authorized Official Telephone | 7016630379 |
| Is Organization Subpart | Y |
| Parent Organization Name | HIT INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 320900000X | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | ND | Residential Treatment Facilities | |
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ND | 1455894 | 05 | |
| ND | 003200006 | 05 |
| Other Name | Type Code |
|---|---|
| Dianes group home | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | 304 & 21ST AVE SW, LLC | 1020 S 344th St Ste 201, Federal Way, WA 98003-8711 |
| Colorado Business Entities | 304 13th Ave | 417 Garfield St., Fort Collins, CO 80254 |
| New York State Corporations | 304 15TH ST. REALTY CORP. | Pob 523, Van Brundt Station, Brooklyn, New York 11215 |
| Iowa Business Entities | 304 15TH STREET, LLC | 215 East 3rd Street, Suite 300, Des Moines, IA 50309 |
| New York State Corporations | 304 21ST STREET REALTY CORP. | 1345 81st Street, Brooklyn, Ny 11228 |
| New York State Corporations | 304 21ST STREET, LLC | C/p Salvatore Garzillo, 1345 81st Street, Brooklyn, Ny 11228 |
| Washington State Corporations | 304 25TH AVE S LLC | 7276 N Mercer Way, Mercer Island, WA 98040-2132 |
| Virginia Business Entities | 304 28TH Street LLC | 3724 Seward Ln, Frederick, Maryland 21704 |
| New York State Corporations | 304 3RD AVE. REST. CORP. | 304 Third Avenue, New York, Ny 10010 |
| New York State Corporations | 304 8TH AVENUE LLC | 304 8th Avenue, New York, Ny 10001 |
| Street Address |
304 11TH ST NE |
| City | MANDAN |
| State | ND |
| Zip Code | 58554-2140 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548782790 | 1150 Group Home | Intermediate Care Facility, Mentally Retarded | 1150 N. Collins Aveue, Mandan, ND 58554 | 2017-07-10 |
| 1871029033 | Anthony Kozojed | Case Manager/Care Coordinator | 701 16th Ave Se, Mandan, ND 58554 | 2017-05-10 |
| 1437690609 | 1140 Grouphome | Intermediate Care Facility, Mentally Retarded | 1140 Collins Ave, Mandan, ND 58554 | 2017-03-20 |
| 1497157895 | West River Head Start | Public Health or Welfare | 1004 7th St Nw, Mandan, ND 58554 | 2014-09-17 |
| 1093134017 | St. Alexius Mandan Pharmacy, LLC | Pharmacy | 2500 Sunset Drive Nw, Suite 2, Mandan, ND 58554 | 2014-04-08 |
| 1639501141 | Lakewood Landing, Inc. | Assisted Living Facility | 4401 21st St Se, Mandan, ND 58554 | 2013-08-07 |
| 1578835641 | Hit Inc. 1301 Grouphome | Intermediate Care Facility, Mentally Retarded | 1301 7th Ave Se, Mandan, ND 58554 | 2012-02-03 |
| 1689953036 | Timothy Lee Ulledahl | Physical Therapy Assistant | 1833 East Bismarck Expressway, Bismarck, ND 58554 | 2011-08-16 |
| 1316232887 | Nagel Family Chiropractic and Wellness LLC | Chiropractor | 2008 Twin City Drive, Mandan, ND 58554 | 2011-06-13 |
| 1598062143 | 1201 Grouphome | Intermediate Care Facility, Mentally Retarded | 1201 7th Ave Se, Mandan, ND 58554 | 2011-02-17 |
| Find all providers in zip 58554 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961391 | Hit Inc. | Community/Behavioral Health | 1007 18th St Nw, Mandan, ND 58554-1639 | 2020-10-30 |
| 1053912493 | Hit Inc. | Community/Behavioral Health | 2640 Sunset Dr, Mandan, ND 58554-1541 | 2020-11-03 |
| 1972101343 | Easter Seals Goodwill Nd, Inc. | Community/Behavioral Health | 211 Collins Ave, Mandan, ND 58554-3106 | 2020-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023619962 | Alpha Opportunities, Inc. | Community/Behavioral Health | 705 14th St Ne, Jamestown, ND 58401-2626 | 2020-11-06 |
| 1811598758 | Alpha Opportunities, Inc. | Community/Behavioral Health | 906 9th Ave Ne, Jamestown, ND 58401-6503 | 2020-11-06 |
| 1619578077 | Hit Inc. | Community/Behavioral Health | 1517/1519 S Washington St, Bismarck, ND 58504 | 2020-11-03 |
| 1518568963 | Hit Inc. | Community/Behavioral Health | 1509/1511 S Washington St., Bismarck, ND 58504 | 2020-11-03 |
| 1922608330 | Red River Human Services Foundation | Community/Behavioral Health | 608 4th St S, Wahpeton, ND 58075-4741 | 2020-10-27 |
| 1942800263 | Red River Human Services Foundation | Community/Behavioral Health | 808 6th St S, Wahpeton, ND 58075-4801 | 2020-10-27 |
| 1134729478 | Red River Human Services Foundation | Community/Behavioral Health | 812 6th St S, Wahpeton, ND 58075-4870 | 2020-10-27 |
| 1114527322 | 4th Corporaiton | Community/Behavioral Health | 1006 2nd Avenue North, New Rockford, ND 58356 | 2020-10-27 |
| 1295335495 | 4th Corporaiton | Community/Behavioral Health | 120 11th Street North, New Rockford, ND 58356 | 2020-10-27 |
| 1740880228 | Red River Human Services Foundation | Community/Behavioral Health | 109 4th Ave S, Wahpeton, ND 58075-4764 | 2020-10-26 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on 304.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.