NPIMap

Organization Active NPI

1201 Grouphome

  • Intellectual Disabilities Intermediate Care Facility
  • Mandan, ND
National Provider Identifier
1598062143
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
1201 GROUPHOME
Practice address
1201 7TH Ave SE
Mandan, ND 58554
Phone
(701) 663-9719
NPI assigned
Feb 17, 2011
Last updated
Apr 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
HIT INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Mike Remboldt
Title
Ceo
Phone
(701) 663-0379

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

1201 7TH Ave SE
Mandan, ND 58554

Mailing address

201 4TH Ave NW
Mandan, ND 58554-3135

Other identifiers 1

IdentifierTypeStateIssuer
30877MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598062143. Details of each certification follow.

  • CCN 35G080 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 35G080

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
HIT 1201
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Feb 16, 2011
Last certification
Jan 22, 2025
Beds
4
Ownership / control type
Private (non-profit)
Facility address
1201 7TH Ave SE
Mandan, ND 58554

National Provider Directory

National Provider Directory
Tax ID family
1203 Grouphome22 organizations share this tax ID, including this one
Part of
1203 Grouphome

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Locations

1201 7th Ave SE
Mandan, ND 58554
Phone (701) 663-9719

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1297900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1598062143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 4TH AVE NW",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "585543135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 7TH AVE SE",
            "city": "MANDAN",
            "state": "ND",
            "postal_code": "58554",
            "telephone_number": "701-663-9719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1201 GROUPHOME",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HIT INC.",
        "enumeration_date": "2011-02-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "REMBOLDT",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "701-663-0379",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30877",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mandan, ND

Sources for this page

Verify at the official NPI Registry.