Healthcare Provider Details

I. General information

NPI: 1417655812
Provider Name (Legal Business Name): CLOUD CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 23RD ST S STE D
FARGO ND
58103-3759
US

IV. Provider business mailing address

1323 23RD ST S STE D
FARGO ND
58103-3759
US

V. Phone/Fax

Practice location:
  • Phone: 701-320-2102
  • Fax:
Mailing address:
  • Phone: 701-320-2102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: IFRAH LAITOUSSI
Title or Position: MANAGER
Credential:
Phone: 701-404-0190