Healthcare Provider Details

I. General information

NPI: 1720948227
Provider Name (Legal Business Name): SAFECIRCLE WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4357 13TH AVE S STE 206B
FARGO ND
58103-7505
US

IV. Provider business mailing address

4357 13TH AVE S STE 206B
FARGO ND
58103-7505
US

V. Phone/Fax

Practice location:
  • Phone: 701-730-8274
  • Fax:
Mailing address:
  • Phone: 701-895-2500
  • Fax: 701-895-2500

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 Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: SHUKRI ALI
Title or Position: MANAGING MEMBER
Credential:
Phone: 701-730-8274