Provider Demographics
NPI:1871795526
Name:ND TEEN CHALLENGECHRIST CENTERED TREATMENT PROGRAM
Entity type:Organization
Organization Name:ND TEEN CHALLENGECHRIST CENTERED TREATMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMMING
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROLLAND
Authorized Official - Last Name:SJOSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-667-2131
Mailing Address - Street 1:1406 2ND ST NW
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-4904
Mailing Address - Country:US
Mailing Address - Phone:701-667-2131
Mailing Address - Fax:701-663-3494
Practice Address - Street 1:1406 2ND ST NW
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-4904
Practice Address - Country:US
Practice Address - Phone:701-667-2131
Practice Address - Fax:701-663-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND118563245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children