| Organization Name: | CIRCLE OF LIFE ALCOHOL PROGRAM |
| NPI Number: | 1477786051 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STELLA BERQUIST (CEO) |
| Mailing Address: | 304 7th St N New Town |
| State: | ND US |
| Postal Code: | 587639402 |
| Phone Number: | 7016274700 |
| Fax Number: | 7016274105 |
| NPI Enumeration Date: | 08/28/2009 |
| NPI Last Update Date: | 01/14/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1115 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ND |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |