Provider Demographics
NPI:1598164972
Name:OPEN MINDS PSYCHIATRIC SERVICES
Entity Type:Organization
Organization Name:OPEN MINDS PSYCHIATRIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHIATRIC CLINICAL NURSE SPECIALI
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MOOS
Authorized Official - Suffix:
Authorized Official - Credentials:PMH CNS-BC
Authorized Official - Phone:701-952-9600
Mailing Address - Street 1:104 1ST AVE S STE 300
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-4194
Mailing Address - Country:US
Mailing Address - Phone:701-952-9600
Mailing Address - Fax:701-952-9605
Practice Address - Street 1:104 1ST AVE S STE 300
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-4194
Practice Address - Country:US
Practice Address - Phone:701-952-9600
Practice Address - Fax:701-952-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-21
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR33306251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND56542Medicaid