Healthcare Provider Details

I. General information

NPI: 1811614704
Provider Name (Legal Business Name): CATHOLIC CHARITIES NORTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2022
Last Update Date: 10/21/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 BISHOPS BLVD S STE B
FARGO ND
58104-7605
US

IV. Provider business mailing address

5201 BISHOPS BLVD S STE B
FARGO ND
58104-7605
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-7993
  • Fax: 701-866-3015
Mailing address:
  • Phone: 701-356-7993
  • Fax: 701-866-3015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier58504
Identifier TypeOTHER
Identifier StateND
Identifier IssuerLOCATION ZIP CODE

VIII. Authorized Official

Name: DELRAE AMANN
Title or Position: CREDENTIALING REPRESENTATIVE
Credential:
Phone: 701-371-6166