Healthcare Provider Details

I. General information

NPI: 1366378390
Provider Name (Legal Business Name): WOMEN INITIATIVE NETWORK OF LIBERIA IN CASS & CLAY COUNTIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 21ST ST S STE 104
FARGO ND
58103-1435
US

IV. Provider business mailing address

15 21ST ST S STE 104
FARGO ND
58103-1435
US

V. Phone/Fax

Practice location:
  • Phone: 701-491-0578
  • Fax: 701-491-0578
Mailing address:
  • Phone: 701-491-0578
  • Fax: 701-491-0578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. PRECIOUS Y DWEH
Title or Position: CEO/PROGRAM DIRECTOR
Credential: DWEH
Phone: 701-491-0578