NPIMap

Organization Active NPI

4TH Corporation

  • Intellectual Disabilities Intermediate Care Facility
  • New Rockford, ND
National Provider Identifier
1669640942
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
ND01161 Issued in ND
Legal business name
4TH CORPORATION
Practice address
120 11TH St N
New Rockford, ND 58356-1434
Phone
(701) 947-2147
NPI assigned
Feb 20, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Authorized official

Name
Kodi Keller
Title
Business Manager
Phone
(701) 947-2147

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X ND01161 ND Primary

Addresses

Primary practice location

120 11TH St N
New Rockford, ND 58356-1434

Mailing address

120 11TH St N
New Rockford, ND 58356-1434
Phone (701) 947-2147

Other identifiers 1

IdentifierTypeStateIssuer
30818MedicaidND

National Provider Directory

National Provider Directory
Tax ID family
4TH Corporaiton5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

NPI Registry JSON

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1669640942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 11TH ST N",
            "city": "NEW ROCKFORD",
            "state": "ND",
            "postal_code": "583561434",
            "telephone_number": "701-947-2147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 11TH ST N",
            "city": "NEW ROCKFORD",
            "state": "ND",
            "postal_code": "583561434",
            "telephone_number": "701-947-2147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4TH CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "KELLER",
        "authorized_official_first_name": "KODI",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "701-947-2147"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "ND",
            "license": "ND01161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30818",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Rockford, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.