Provider Demographics
NPI:1790385482
Name:PRIDE INC
Entity Type:Organization
Organization Name:PRIDE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:STAIR TESSNESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-712-5125
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:701-712-5125
Mailing Address - Fax:
Practice Address - Street 1:1200 MISSOURI AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5264
Practice Address - Country:US
Practice Address - Phone:701-712-5125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRIDE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-30
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456378Medicaid