Provider Demographics
NPI:1366023491
Name:AMACHI MENTORING
Entity Type:Organization
Organization Name:AMACHI MENTORING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGSRUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-662-6767
Mailing Address - Street 1:414 4TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2458
Mailing Address - Country:US
Mailing Address - Phone:701-662-6767
Mailing Address - Fax:
Practice Address - Street 1:414 4TH AVE NE
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2458
Practice Address - Country:US
Practice Address - Phone:701-662-6767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility