Provider Demographics
NPI:1194807420
Name:TRI-LIFE CENTER L.L.P.
Entity type:Organization
Organization Name:TRI-LIFE CENTER L.L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:K
Authorized Official - Last Name:SJOL
Authorized Official - Suffix:
Authorized Official - Credentials:RNC
Authorized Official - Phone:701-837-5433
Mailing Address - Street 1:PO BOX 2023
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58702-2023
Mailing Address - Country:US
Mailing Address - Phone:701-837-5433
Mailing Address - Fax:701-837-5434
Practice Address - Street 1:2401 ELK DR
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-5631
Practice Address - Country:US
Practice Address - Phone:701-837-5433
Practice Address - Fax:701-837-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDB001OtherTRICARE
ND10298OtherBCBS
ND354505Medicare Oscar/Certification
ND10298OtherBCBS