Provider Demographics
NPI:1508212069
Name:GACKLE FUTURE DEVELOPMENT COMPANY
Entity Type:Organization
Organization Name:GACKLE FUTURE DEVELOPMENT COMPANY
Other - Org Name:GACKLE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-485-3395
Mailing Address - Street 1:304 1ST AVE W
Mailing Address - Street 2:PO BOX 335
Mailing Address - City:GACKLE
Mailing Address - State:ND
Mailing Address - Zip Code:58442-7219
Mailing Address - Country:US
Mailing Address - Phone:701-485-3395
Mailing Address - Fax:701-485-3962
Practice Address - Street 1:304 1ST AVE W
Practice Address - Street 2:
Practice Address - City:GACKLE
Practice Address - State:ND
Practice Address - Zip Code:58442
Practice Address - Country:US
Practice Address - Phone:701-485-3395
Practice Address - Fax:701-485-3962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND8014311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility