Provider Demographics
NPI:1326469883
Name:COMMUNITY EXTENDED NUCLEAR TRANSITIONAL RESIDENCE FOR EX-OFFENDERS
Entity Type:Organization
Organization Name:COMMUNITY EXTENDED NUCLEAR TRANSITIONAL RESIDENCE FOR EX-OFFENDERS
Other - Org Name:CENTRE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:HELMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-373-8312
Mailing Address - Street 1:123 15TH ST N
Mailing Address - Street 2:P. O. BOX 1269
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-4220
Mailing Address - Country:US
Mailing Address - Phone:701-373-8356
Mailing Address - Fax:701-893-9165
Practice Address - Street 1:123 15TH ST N
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58102-4220
Practice Address - Country:US
Practice Address - Phone:701-373-8356
Practice Address - Fax:701-893-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2013-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1077101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty