Healthcare Provider Details

I. General information

NPI: 1093514432
Provider Name (Legal Business Name): SPERANZA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2025
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 45TH ST S
FARGO ND
58104-8962
US

IV. Provider business mailing address

3523 45TH ST S
FARGO ND
58104-8962
US

V. Phone/Fax

Practice location:
  • Phone: 832-863-0858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: WINNIFRED FLOBERG
Title or Position: CASE COORDINATOR
Credential:
Phone: 832-863-0858