Provider Demographics
NPI:1326855669
Name:ABUNDANT GRACE RECOVERY
Entity type:Organization
Organization Name:ABUNDANT GRACE RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LMAC
Authorized Official - Prefix:
Authorized Official - First Name:SHONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STIVERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMAC
Authorized Official - Phone:701-641-0313
Mailing Address - Street 1:623 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-5317
Mailing Address - Country:US
Mailing Address - Phone:701-641-0313
Mailing Address - Fax:
Practice Address - Street 1:623 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-5317
Practice Address - Country:US
Practice Address - Phone:701-641-0313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty