Healthcare Provider Details

I. General information

NPI: 1053252387
Provider Name (Legal Business Name): FATHERS RISE TOGETHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2024 W 3RD ST
DULUTH MN
55806-2053
US

IV. Provider business mailing address

2024 W 3RD ST
DULUTH MN
55806-2053
US

V. Phone/Fax

Practice location:
  • Phone: 218-390-9204
  • Fax:
Mailing address:
  • Phone: 218-390-9204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHAQUANA MCENTYRE
Title or Position: FOUNDER
Credential:
Phone: 218-461-1722