Provider Demographics
NPI:1558976449
Name:HARMONY HOUSE
Entity Type:Organization
Organization Name:HARMONY HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BAIRD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:SUNDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:701-740-1555
Mailing Address - Street 1:1601 COLLEGE DR N
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-1550
Mailing Address - Country:US
Mailing Address - Phone:701-662-7640
Mailing Address - Fax:
Practice Address - Street 1:1601 COLLEGE DR N
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-1550
Practice Address - Country:US
Practice Address - Phone:701-662-7640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1225217300Medicaid