Provider Demographics
NPI:1548432537
Name:FAMILY RESOURCE CENTER
Entity Type:Organization
Organization Name:FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:AMELIA
Authorized Official - Last Name:VIVIER
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:701-477-6786
Mailing Address - Street 1:PO BOX 933
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-0933
Mailing Address - Country:US
Mailing Address - Phone:701-477-6786
Mailing Address - Fax:701-477-6312
Practice Address - Street 1:BIA HWY 10
Practice Address - Street 2:
Practice Address - City:BELCOURT
Practice Address - State:ND
Practice Address - Zip Code:58316
Practice Address - Country:US
Practice Address - Phone:701-477-6786
Practice Address - Fax:701-477-6312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1870251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1D059760Medicaid