Provider Demographics
NPI:1669743639
Name:NORTH HOMES, INC. CHEMICAL DEPENDENCY BUHL
Entity type:Organization
Organization Name:NORTH HOMES, INC. CHEMICAL DEPENDENCY BUHL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY ASSURANCE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-327-3000
Mailing Address - Street 1:1880 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-4085
Mailing Address - Country:US
Mailing Address - Phone:218-327-3000
Mailing Address - Fax:218-327-1871
Practice Address - Street 1:200 WANLESS STREET
Practice Address - Street 2:
Practice Address - City:BUHL
Practice Address - State:MN
Practice Address - Zip Code:55713
Practice Address - Country:US
Practice Address - Phone:218-327-3000
Practice Address - Fax:218-327-1871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1059813-1-CDT251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health