Provider Demographics
NPI:1730212325
Name:THE ENRICHMENT GARDEN
Entity type:Organization
Organization Name:THE ENRICHMENT GARDEN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-258-1569
Mailing Address - Street 1:PO BOX 2536
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58502-2536
Mailing Address - Country:US
Mailing Address - Phone:701-258-1569
Mailing Address - Fax:701-223-1669
Practice Address - Street 1:1138 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-3556
Practice Address - Country:US
Practice Address - Phone:701-258-1569
Practice Address - Fax:701-223-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND376261QD1600X
261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND59243Medicaid
ND027312OtherBLUE CROSS BLUE SHIELD
ND59160Medicaid
ND55053Medicaid
ND599001OtherBLUE CROSS BLUE SHIELD
ND7770280Medicaid
ND25799OtherBLUE CROSS BLUE SHIELD
ND51207Medicaid
ND027311OtherBLUE CROSS BLUE SHIELD
ND12168OtherBLUE CROSS BLUE SHIELD
ND1458770Medicaid