Healthcare Provider Details

I. General information

NPI: 1225459027
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF ND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 04/21/2020
Certification Date: 04/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3911 20TH AVE S
FARGO ND
58107
US

IV. Provider business mailing address

PO BOX 389
FARGO ND
58107-0389
US

V. Phone/Fax

Practice location:
  • Phone: 701-235-7341
  • Fax: 701-271-3270
Mailing address:
  • Phone: 701-235-7341
  • Fax: 701-271-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. JESSICA THOMASSON
Title or Position: CEO
Credential:
Phone: 701-235-7341