MEDICARE: HEALING CENTER COMMUNITY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	106S00000X	Behavior Technician
3	163WR0400X	Rehabilitation Registered Nurse
4	376K00000X	Nurse's Aide
5	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1124963947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALING CENTER COMMUNITY CARE LLC

Provider Business Mailing Address
First Line	:	536 45TH ST S APT 202
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-0903
Country	:	US
Telephone Number	:	701-540-1191
Fax Number	:

Provider Business Practice Location Address
First Line	:	536 45TH ST S APT 202
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-0903
Country	:	US
Telephone Number	:	701-540-1191
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KHALIYAH MARSHALL
Credential	:
Telephone Number	:	701-540-1191

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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