Healthcare Provider Details

I. General information

NPI: 1538253646
Provider Name (Legal Business Name): HOSPICE OF THE RED RIVER VALLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 56TH AVE S
FARGO ND
58104-6706
US

IV. Provider business mailing address

3800 56TH AVE S
FARGO ND
58104-6706
US

V. Phone/Fax

Practice location:
  • Phone: 701-356-1500
  • Fax:
Mailing address:
  • Phone: 800-237-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number55352
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: THERESA STAHL
Title or Position: CFO
Credential:
Phone: 701-356-1507