Provider Demographics
NPI:1982135430
Name:LEWIS GOOD HOUSE
Entity Type:Organization
Organization Name:LEWIS GOOD HOUSE
Other - Org Name:CHEMICAL HEALTH CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISHAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-221-1764
Mailing Address - Street 1:3315 UNIVERSITY DR
Mailing Address - Street 2:WELLNESS CENTER
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504
Mailing Address - Country:US
Mailing Address - Phone:701-221-1747
Mailing Address - Fax:701-530-0645
Practice Address - Street 1:3315 UNIVERSITY DR
Practice Address - Street 2:WELLNESS CENTER
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504
Practice Address - Country:US
Practice Address - Phone:701-221-1747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder