CMS-1500 Box 24J / 33a • NPI
1437690609
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
315P00000X (CMS A2[9])
Licensed & Credentialed Nursing & Custodial Care Facilities — Intermediate Care Facility, Mentally Retarded
Box 32 Service Location & ZIP+4
1140 COLLINS AVE, MANDAN, ND, 58554
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1437690609 (1140 GROUPHOME) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1437690609 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | 1140 GROUPHOME |
| Plain-English Specialty | Licensed & Credentialed Nursing & Custodial Care Facilities — Intermediate Care Facility, Mentally Retarded NUCC Code: 315P00000X (Intermediate Care Facility, Intellectual Disabilities) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1140 COLLINS AVE, MANDAN, ND, 58554 |
| Practice Telephone / Fax | Tel: (701) 663-0379 |
| Administrative Mailing Address | 201 4TH AVE NW, MANDAN, ND, 58554-3135 |
| Enumeration & Last Sync | Enumerated: 2017-03-20 | CMS Record Updated: 2024-04-17 |
| Authorized Official | MIKE REMBOLDT (CEO) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (315P00000X)
What Does Taxonomy Code 315P00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 315P00000X translates to:
"Licensed & Credentialed Nursing & Custodial Care Facilities — Intermediate Care Facility, Mentally Retarded"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (1140 GROUPHOME)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
315P00000X — Intermediate Care Facility, Intellectual DisabilitiesPlain English: Licensed & Credentialed Nursing & Custodial Care Facilities — Intermediate Care Facility, Mentally Retarded | State: ND | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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