NPI 1184171753

Dakota Renaissance, INC.

Organisation Substance Abuse Rehabilitation Facility Pettibone, ND

Practice location

Address: 101 3rd Ave # 44, Pettibone, ND 58475
Phone: (701) 273-6688
Fax: (888) 972-4098
Mailing address: 101 3rd Ave P.O. Box 44, Pettibone, ND 58475

Authorised official

Name: Scharazard Lee Gray
Title: Director
Phone: (813) 310-9346

Registered specialties (2)

Substance Abuse Rehabilitation Facility Primary

Residential Treatment Facilities Taxonomy 324500000X Licence 12015 (ND)

Other Substance Abuse Rehabilitation Facility providers in North Dakota →

Research Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QR1100X Licence 12015 (ND)

Other Clinic/Center providers in North Dakota →

Registry record

NPI: 1184171753
Entity type: Organization
NPI issued: 1 Sep 2016
Record last updated: 1 Sep 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.