Healthcare Provider Details

I. General information

NPI: 1144186941
Provider Name (Legal Business Name): CHRONICLE HOME CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/25/2025
Last Update Date: 12/25/2025
Certification Date: 12/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1848 39TH ST S APT 303
FARGO ND
58103-4437
US

IV. Provider business mailing address

1848 39TH ST S APT 303
FARGO ND
58103-4437
US

V. Phone/Fax

Practice location:
  • Phone: 701-405-3312
  • Fax:
Mailing address:
  • Phone: 701-405-3312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: CLARA K BALLAH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: RN
Phone: 763-600-9792