Provider Demographics
NPI:1568916989
Name:PRIDE MANCHESTER HOPE HOME INC
Entity Type:Organization
Organization Name:PRIDE MANCHESTER HOPE HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:BISNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-258-7838
Mailing Address - Street 1:PO BOX 4086
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-4086
Mailing Address - Country:US
Mailing Address - Phone:701-751-3013
Mailing Address - Fax:
Practice Address - Street 1:7301 KEEPSAKE LN
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-8664
Practice Address - Country:US
Practice Address - Phone:701-751-3013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIDE MANCHESTER INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND05741322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children