Healthcare Provider Details

I. General information

NPI: 1154041663
Provider Name (Legal Business Name): SIMPLICITY HOME CARE OF NORTH DAKOTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2022
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3523 45TH ST S
FARGO ND
58104-8962
US

IV. Provider business mailing address

PO BOX 66539
ALBUQUERQUE NM
87193-6539
US

V. Phone/Fax

Practice location:
  • Phone: 605-600-3737
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health 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: STEVE TRACY
Title or Position: MANAGING MEMBER
Credential:
Phone: 505-266-6683