Grand Forks Growth and Support Center

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

GRAND FORKS GROWTH AND SUPPORT CENTER

Practice address

2105 Gateway Dr
Grand Forks, ND 58203-1412

Phone

(701) 775-2566

NPI assigned

Oct 7, 2020

Last updated

Oct 7, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mike Olson

Title

Controller

Phone

(701) 775-2566

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1602028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602028800000",
    "number": "1679170179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2105 GATEWAY DR",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582031412",
            "telephone_number": "701-775-2566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2105 GATEWAY DR",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582031412",
            "telephone_number": "701-775-2566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND FORKS GROWTH AND SUPPORT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-07",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "701-775-2566"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1456174",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Forks Chiropractic
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• Grand Forks Counseling and Therapy PLLC
• Grand Forks County Social Services
• Grand Forks Foot and Ankle Clinic, PLLC
• Grand Forks Head Start
• Grand Forks Public School District
• Grand Forks Public Schools District 1
• Grand Forks Public Schools District 1
• Grand Forks Public Schools District 1

• Community/Behavioral Health Agency in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Community/Behavioral Health Agency in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2020; 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.