Provider Demographics
NPI:1982754552
Name:NUVATION HEALTH SERVICES P.C.
Entity Type:Organization
Organization Name:NUVATION HEALTH SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER-AUTHORIZED SIGNATURE
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:701-391-7968
Mailing Address - Street 1:600 SOUTH 2ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5729
Mailing Address - Country:US
Mailing Address - Phone:701-258-3780
Mailing Address - Fax:701-258-6431
Practice Address - Street 1:600 SOUTH 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5729
Practice Address - Country:US
Practice Address - Phone:701-258-3780
Practice Address - Fax:701-258-6431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
ND2899101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19160Medicaid
119426OtherHEALTH PARTNERS
711826Medicare PIN
ND19160Medicaid