Family Recovery Home

Primary specialty

Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X

Legal business name

FAMILY RECOVERY HOME

Practice address

126 W Broadway
Williston, ND 58801-6053

Phone

(701) 774-9625

Fax

(701) 572-4106

NPI assigned

Apr 5, 2006

Organization subpart

No

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

Authorized official

Name

Diana Roy, LAC

Title

Executive Director

Phone

(701) 774-9625

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730141763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 W BROADWAY",
            "address_2": "PO BOX 1202",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588021202",
            "telephone_number": "701-774-9625",
            "fax_number": "701-572-4106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "126 W BROADWAY",
            "city": "WILLISTON",
            "state": "ND",
            "postal_code": "588016053",
            "telephone_number": "701-774-9625",
            "fax_number": "701-572-4106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY RECOVERY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ROY",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "701-774-9625",
        "authorized_official_credential": "LAC"
    },
    "taxonomies": [
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B LUE CROSS",
            "identifier": "01280003",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.