Provider Demographics
NPI:1083823546
Name:WHOLE PERSON RECOVERY CENTER
Entity type:Organization
Organization Name:WHOLE PERSON RECOVERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:GROVE
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED ADDICTION
Authorized Official - Phone:701-224-1261
Mailing Address - Street 1:1138 SUMMIT BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-5280
Mailing Address - Country:US
Mailing Address - Phone:701-224-1261
Mailing Address - Fax:
Practice Address - Street 1:1138 SUMMIT BOULEVARD
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-5280
Practice Address - Country:US
Practice Address - Phone:701-224-1261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1040101YA0400X
ND1257101YA0400X
ND84719120101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND9214OtherPIN NUMBER BCBS ND
ND17995OtherPIN NUMBER BCBS ND
ND9215OtherPIN NUMBER BCBS ND