Provider Demographics
NPI:1003832783
Name:FAMILY INSTITUTE, PC
Entity Type:Organization
Organization Name:FAMILY INSTITUTE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:RAIN
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:701-772-1588
Mailing Address - Street 1:2100 S COLUMBIA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-5895
Mailing Address - Country:US
Mailing Address - Phone:701-772-1588
Mailing Address - Fax:701-746-6077
Practice Address - Street 1:2100 S COLUMBIA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-5895
Practice Address - Country:US
Practice Address - Phone:701-772-1588
Practice Address - Fax:701-746-6077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND184103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND18321Medicaid
ND70328Medicare ID - Type Unspecified